Provider Demographics
NPI:1629205828
Name:THOM, TATIANA ARILHA (MD)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:ARILHA
Last Name:THOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:CONSTANTINO
Other - Last Name:ARILHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:54 COURT ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3201
Mailing Address - Country:US
Mailing Address - Phone:508-821-2500
Mailing Address - Fax:508-821-2122
Practice Address - Street 1:54 COURT ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3201
Practice Address - Country:US
Practice Address - Phone:508-821-2500
Practice Address - Fax:508-821-2122
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT51045207R00000X
FLME116225207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008910900Medicaid
FLHJ710ZMedicare PIN