Provider Demographics
NPI:1255869699
Name:MATHEW THOMAS, VINAY (MBBS)
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:
Last Name:MATHEW THOMAS
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N 1900 E RM 5C402
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0002
Mailing Address - Country:US
Mailing Address - Phone:801-585-0120
Mailing Address - Fax:
Practice Address - Street 1:30 N 1900 E RM 5C402
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0002
Practice Address - Country:US
Practice Address - Phone:801-585-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2024-04-15
Deactivation Date:2018-01-03
Deactivation Code:
Reactivation Date:2018-01-18
Provider Licenses
StateLicense IDTaxonomies
UT12256053-1205207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology