Provider Demographics
NPI:1548289515
Name:KERRIHARD, THOMAS NELSON (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:NELSON
Last Name:KERRIHARD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:859 N SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-7423
Mailing Address - Country:US
Mailing Address - Phone:310-360-6364
Mailing Address - Fax:310-360-0868
Practice Address - Street 1:450 N ROBERTSON BLVD FL 2
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1732
Practice Address - Country:US
Practice Address - Phone:310-360-6364
Practice Address - Fax:310-360-0868
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG0853112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG49044Medicare UPIN