Provider Demographics
NPI:1609837905
Name:THAMMAN, PREM (MD)
Entity Type:Individual
Prefix:DR
First Name:PREM
Middle Name:
Last Name:THAMMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 GARIBALDI AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-3709
Mailing Address - Country:US
Mailing Address - Phone:973-773-3556
Mailing Address - Fax:973-773-2337
Practice Address - Street 1:361 GARIBALDI AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-3709
Practice Address - Country:US
Practice Address - Phone:973-773-3556
Practice Address - Fax:973-773-2337
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25641207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1384400Medicaid
NJ1384400Medicaid
C61014Medicare UPIN