Provider Demographics
NPI:1922284181
Name:WINGO, THOMAS S (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:WINGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 ALHAMBRA BLVD STE 200A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7042
Mailing Address - Country:US
Mailing Address - Phone:916-734-7127
Mailing Address - Fax:916-734-6525
Practice Address - Street 1:1651 ALHAMBRA BLVD STE 200A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7042
Practice Address - Country:US
Practice Address - Phone:916-734-7127
Practice Address - Fax:916-734-6525
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0610202084N0400X
CAC1942672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology