Provider Demographics
NPI:1558503326
Name:ODERMATT, THADDAEUS WALTER JOSEF (MD)
Entity Type:Individual
Prefix:DR
First Name:THADDAEUS
Middle Name:WALTER JOSEF
Last Name:ODERMATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:130 FREDERICK ST
Mailing Address - Street 2:APT 302
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-4056
Mailing Address - Country:US
Mailing Address - Phone:415-216-5025
Mailing Address - Fax:415-476-9516
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:415-476-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF5521207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology