Provider Demographics
NPI:1124214226
Name:FERNANDEZ, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:FERNANDEZ
Suffix:
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:PO BOX 207900
Mailing Address - Street 2:230 SOUTH FRONTAGE ROAD
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-7900
Mailing Address - Country:US
Mailing Address - Phone:203-785-2559
Mailing Address - Fax:203-785-7400
Practice Address - Street 1:230 SOUTH FRONTAGE ROAD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-7900
Practice Address - Country:US
Practice Address - Phone:203-785-2559
Practice Address - Fax:203-785-7400
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0457412084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry