1396925467 NPI number — IRA M. THAL, MD, PC

Table of content: (NPI 1396925467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396925467 NPI number — IRA M. THAL, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRA M. THAL, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396925467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 W LANCASTER AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
PAOLI
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19301-1763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-647-5544
Provider Business Mailing Address Fax Number:
610-647-5545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 W LANCASTER AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
PAOLI
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19301-1763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-647-5544
Provider Business Practice Location Address Fax Number:
610-647-5545
Provider Enumeration Date:
11/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THAL
Authorized Official First Name:
IRA
Authorized Official Middle Name:
MERVYN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-647-5544

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD044987L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110241724 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0560080000 . This is a "KEYSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: TH1413362 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4339125 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1413362 . This is a "PERSONAL CHOICE" identifier . This identifiers is of the category "OTHER".




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