Provider Demographics
NPI:1033297833
Name:GONDA, THOMAS A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:GONDA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 MOUNTAIN BLVD
Mailing Address - Street 2:#240
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2958
Mailing Address - Country:US
Mailing Address - Phone:510-495-4826
Mailing Address - Fax:888-960-9076
Practice Address - Street 1:2220 MOUNTAIN BLVD
Practice Address - Street 2:#240
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2958
Practice Address - Country:US
Practice Address - Phone:510-495-4826
Practice Address - Fax:888-960-9076
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG604092084P0800X
CAMFC50715106H00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)