Provider Demographics
NPI:1962700583
Name:THOMAS, SUTHA (MD)
Entity type:Individual
Prefix:
First Name:SUTHA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 RIDGEVIEW DR STE 130
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5443
Mailing Address - Country:US
Mailing Address - Phone:214-383-0434
Mailing Address - Fax:214-383-3178
Practice Address - Street 1:940 RIDGEVIEW DR STE 130
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5443
Practice Address - Country:US
Practice Address - Phone:214-383-0434
Practice Address - Fax:214-383-3178
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-06
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2156208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283493901Medicaid