Provider Demographics
NPI:1265484240
Name:THACH, ANDREA MINOR (MD)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MINOR
Last Name:THACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-204-3410
Mailing Address - Fax:510-204-3411
Practice Address - Street 1:3100 SUMMIT ST FL 2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3412
Practice Address - Country:US
Practice Address - Phone:510-204-3410
Practice Address - Fax:510-204-3411
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021008207R00000X, 207RH0002X
CA53457207R00000X
CAG53457207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52527Medicare UPIN