Provider Demographics
NPI:1659630622
Name:THOMAS J ASCIUTO MD CORPORATION
Entity Type:Organization
Organization Name:THOMAS J ASCIUTO MD CORPORATION
Other - Org Name:THOMAS J ASCIUTO MD CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ASCIUTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-861-4545
Mailing Address - Street 1:18111 BROOKHURST ST
Mailing Address - Street 2:SUITE 4600
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6728
Mailing Address - Country:US
Mailing Address - Phone:714-861-4545
Mailing Address - Fax:714-861-4549
Practice Address - Street 1:18111 BROOKHURST ST
Practice Address - Street 2:SUITE 4600
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6728
Practice Address - Country:US
Practice Address - Phone:714-861-4545
Practice Address - Fax:714-861-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43500Medicare UPIN