Provider Demographics
NPI:1801004825
Name:THOMAS, VIBHA TANEJA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIBHA
Middle Name:TANEJA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIBHA
Other - Middle Name:
Other - Last Name:TANEJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:5352 NORTH JOSEY LANE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:972-397-7368
Practice Address - Fax:972-394-4941
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49952207RH0003X
TXN2831207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX357011101Medicaid
TXP01701262OtherRAILROAD
CO36325015Medicaid
TXP01701262OtherRAILROAD
TX357011101Medicaid