Provider Demographics
NPI:1538513296
Name:AYKKARETH THOMAS, GINU
Entity Type:Individual
Prefix:DR
First Name:GINU
Middle Name:
Last Name:AYKKARETH THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AYKKARETH HOUSE, PANDANAD NORTH P O
Mailing Address - Street 2:KALLISSERY
Mailing Address - City:CHENGANOOR
Mailing Address - State:KERALA
Mailing Address - Zip Code:689124
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-887-3585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NMMD2021-11412085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology