Provider Demographics
NPI:1356541981
Name:THOMAS B. CHODOSH, D.O., P.A.
Entity type:Organization
Organization Name:THOMAS B. CHODOSH, D.O., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHODOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-215-1786
Mailing Address - Street 1:PO BOX 270298
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-0298
Mailing Address - Country:US
Mailing Address - Phone:361-215-1786
Mailing Address - Fax:361-992-1835
Practice Address - Street 1:6302 RAMSGATE CIR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3632
Practice Address - Country:US
Practice Address - Phone:361-215-1786
Practice Address - Fax:361-992-1835
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS B. CHODOSH, D.O., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-23
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0056KYOtherBCBS
TX164150801Medicaid
TXD75116Medicare UPIN
TX0056KYOtherBCBS