Provider Demographics
NPI:1154361061
Name:FLANAGAN, THOMAS A (MD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:5353 MISSION CENTER RD
Practice Address - Street 2:SUITE 224
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1306
Practice Address - Country:US
Practice Address - Phone:619-688-5855
Practice Address - Fax:619-291-3310
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG246382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A42325Medicare UPIN
CAW416Medicare PIN
CAWG24638AMedicare PIN