Provider Demographics
NPI:1245297209
Name:UNGARINO, THOMAS JUDE (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JUDE
Last Name:UNGARINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 72105
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-2105
Mailing Address - Country:US
Mailing Address - Phone:229-438-5864
Mailing Address - Fax:229-438-1004
Practice Address - Street 1:804 13TH AVENUE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701
Practice Address - Country:US
Practice Address - Phone:229-438-5864
Practice Address - Fax:229-438-1004
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043799207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA29000009849OtherRR MEDICARE
GA52545954001OtherSTATE MERIT
GA545954OtherBCBS
GA00761362AMedicaid
GAF09480Medicare UPIN
GA81BBBCBMedicare ID - Type UnspecifiedCAHABA MEDICARE PROVIDER