Provider Demographics
NPI:1336499151
Name:THOMAS, GEORGE THEKKANATTU (PA-C)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:THEKKANATTU
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8163 MANDAN TER
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2643
Mailing Address - Country:US
Mailing Address - Phone:301-247-0844
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 140 CAMPUS DRIVE
Practice Address - Street 2:UNIVERSITY HEALTH CENTER
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742
Practice Address - Country:US
Practice Address - Phone:301-314-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004724363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical