Provider Demographics
NPI:1275582355
Name:MOHAN THOMAS, PANTHIRUVELIL SCARIA (MD)
Entity Type:Individual
Prefix:
First Name:PANTHIRUVELIL
Middle Name:SCARIA
Last Name:MOHAN THOMAS
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 1:901 MACARTHUR BLVD
Mailing Address - Street 2:ATTN ANESTHESIA
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2901
Mailing Address - Country:US
Mailing Address - Phone:219-836-7040
Mailing Address - Fax:219-513-1127
Practice Address - Street 1:901 MACARTHUR BLVD
Practice Address - Street 2:ATTN ANESTHESIA
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2901
Practice Address - Country:US
Practice Address - Phone:219-836-7040
Practice Address - Fax:219-513-1127
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033040A174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000360915OtherANTHEM BCBS
IN100336350Medicaid
IN000000360915OtherANTHEM BCBS
IN148530CCMedicare PIN