Provider Demographics
NPI:1265052518
Name:THOMAS, ANJU SUZANNA (MD)
Entity type:Individual
Prefix:
First Name:ANJU
Middle Name:SUZANNA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS, ROUTE 1119
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1119
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:409-772-3680
Practice Address - Street 1:6416 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-1033
Practice Address - Country:US
Practice Address - Phone:409-772-3695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10070708208000000X
TXU2337208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics