Provider Demographics
NPI:1578547709
Name:THACHET, CYRIAC THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:CYRIAC
Middle Name:THOMAS
Last Name:THACHET
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 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-425-2424
Mailing Address - Fax:215-425-0342
Practice Address - Street 1:1741 FRANKFORD AVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-2445
Practice Address - Country:US
Practice Address - Phone:215-425-2424
Practice Address - Fax:215-425-0342
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045339L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4622304OtherAETNA PPO
PA538882OtherCOVENTRY HEALTH AMERICA
PA001273951Medicaid
PA110244602OtherRAILROAD MEDICARE
PA2776575OtherAETNA HMO
PA473238OtherAETNA HMO
PA1026843OtherKEYSTONE MERCY HEALTH
PA3Y3535OtherHEALTH NET
PA0546984000OtherINDEPENDENCE BLUE CROSS
PA1461OtherBRAVO HEALTH
PA710859OtherHIGHMARK BLUE SHIELD
PA1100949OtherKEYSTONE MERCY HEALTH
PA110244602OtherRAILROAD MEDICARE
PA710859Medicare PIN