Provider Demographics
NPI:1184725467
Name:MCILRAITH, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MCILRAITH
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67830207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000810608749OtherPHCS
CA00A678300Medicaid
CA7254587OtherAETNA
CA2441706OtherUNITED HEALTHCARE
CA105367OtherHEALTH NET
CA1783233OtherGREAT WEST
CA104558OtherINTERPLAN
CAA67830OtherBLUE CROSS
CA0088964OtherCIGNA
CA2250367OtherFIRST HEALTH
CA90140492OtherPACIFICARE
CAMCMG338200OtherWESTERN HEALTH ADVANTAGE
CA2441706OtherUNITED HEALTHCARE
CA105367OtherHEALTH NET