Provider Demographics
NPI:1942309851
Name:SHIOVITZ, THOMAS MERRILL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MERRILL
Last Name:SHIOVITZ
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 1:4835 VAN NUYS BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:310-285-9421
Mailing Address - Fax:818-986-9716
Practice Address - Street 1:4835 VAN NUYS BLVD
Practice Address - Street 2:STE 104
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:310-285-9421
Practice Address - Fax:818-986-9716
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG531552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A93195Medicare UPIN
CAG53155Medicare ID - Type Unspecified