Provider Demographics
NPI:1649298852
Name:ASCIUTO, THOMAS JOSEPH
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:ASCIUTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DR. THOMAS
Other - Middle Name:J
Other - Last Name:ASCIUTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:18111 BROOKHURST ST 4600
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6728
Mailing Address - Country:US
Mailing Address - Phone:714-861-4545
Mailing Address - Fax:714-861-4549
Practice Address - Street 1:18111 BROOKHURST ST 4600
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6728
Practice Address - Country:US
Practice Address - Phone:714-861-4545
Practice Address - Fax:714-861-4549
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53904207RP1001X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0086880Medicaid
CAGR0086880Medicaid
CAA43500Medicare UPIN