Provider Demographics
NPI:1609819630
Name:STODGEL, THOMAS O (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:O
Last Name:STODGEL
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 1891
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94011-1891
Mailing Address - Country:US
Mailing Address - Phone:650-344-7799
Mailing Address - Fax:650-375-8269
Practice Address - Street 1:1820 OGDEN DR
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-5384
Practice Address - Country:US
Practice Address - Phone:650-344-7799
Practice Address - Fax:650-375-8269
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA049612207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF04007Medicare UPIN