Provider Demographics
NPI:1528559325
Name:THOMAS, MERENE VALIYAKALAYIL (DO)
Entity Type:Individual
Prefix:
First Name:MERENE
Middle Name:VALIYAKALAYIL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1121
Mailing Address - Country:US
Mailing Address - Phone:201-795-8200
Mailing Address - Fax:
Practice Address - Street 1:3800 N TARRANT PKWY STE 210
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5416
Practice Address - Country:US
Practice Address - Phone:682-593-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT4867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine