Provider Demographics
NPI:1457454761
Name:HALLIGAN, THOMAS SEAN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:SEAN
Last Name:HALLIGAN
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 22210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94623-2210
Mailing Address - Country:US
Mailing Address - Phone:510-535-2999
Mailing Address - Fax:510-535-4128
Practice Address - Street 1:1450 FRUITVALE AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2313
Practice Address - Country:US
Practice Address - Phone:510-535-2999
Practice Address - Fax:510-535-4128
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A718700Medicare ID - Type Unspecified
H60240Medicare UPIN