Provider Demographics
NPI:1629217849
Name:THOMAS, DWITHIYA KRISHNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DWITHIYA
Middle Name:KRISHNAN
Last Name:THOMAS
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 1:1469 EIGHTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015
Mailing Address - Country:US
Mailing Address - Phone:610-419-7800
Mailing Address - Fax:610-419-7810
Practice Address - Street 1:1469 EIGHTH AVENUE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015
Practice Address - Country:US
Practice Address - Phone:610-419-7800
Practice Address - Fax:610-419-7810
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08491000207R00000X
PAMD445323207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00831390OtherRR MEDICARE
NJ0206245 (NOTTINGHAM)Medicaid
NJ0206245 (NOTTINGHAM)Medicaid
NJ158265ZD3T (NOTTINGHMedicare PIN