Provider Demographics
NPI:1982908695
Name:THOMAS, ABRAHAM THEKKANATTU (PA-C)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:THEKKANATTU
Last Name:THOMAS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:ABRAHAM
Other - Middle Name:THOMAS
Other - Last Name:THEKKANATTU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3958 BRAVEHEART CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7743
Mailing Address - Country:US
Mailing Address - Phone:240-416-2327
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-8442
Practice Address - Country:US
Practice Address - Phone:301-295-8555
Practice Address - Fax:301-400-0616
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004293363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant