Provider Demographics
NPI:1942241336
Name:RHODEMAN, THOMAS JOHAN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHAN
Last Name:RHODEMAN
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 1:101 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0556
Mailing Address - Country:US
Mailing Address - Phone:209-571-6622
Mailing Address - Fax:209-527-2069
Practice Address - Street 1:1524 MCHENRY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4500
Practice Address - Country:US
Practice Address - Phone:209-577-4444
Practice Address - Fax:209-527-2069
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA481412085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A481410Medicaid
CA300060037Medicare PIN
CAF83701Medicare UPIN
CA00A481411Medicare PIN
CA00A4814112Medicare PIN
CA00A4814115Medicare PIN
CA00A481417Medicare PIN
CA00A4814111Medicare PIN
CA00A481416Medicare PIN
CA00A481419Medicare PIN
CA00A4814114Medicare PIN
CA00A481410Medicaid
CA00A481418Medicare PIN
CA00A4814110Medicare PIN