Provider Demographics
NPI:1538337282
Name:THOMAS P NOWAK MD PHD INC
Entity type:Organization
Organization Name:THOMAS P NOWAK MD PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-357-6953
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-0827
Mailing Address - Country:US
Mailing Address - Phone:858-513-1833
Mailing Address - Fax:858-513-1838
Practice Address - Street 1:515 S SIERRA AVE
Practice Address - Street 2:#109
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2245
Practice Address - Country:US
Practice Address - Phone:858-357-6953
Practice Address - Fax:858-513-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59443207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G594430Medicaid
CAA53496Medicare UPIN