Provider Demographics
NPI:1033128285
Name:THOMAS DUFFIELD, MD, PC
Entity Type:Organization
Organization Name:THOMAS DUFFIELD, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DUFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-225-2975
Mailing Address - Street 1:1200 BUSTLETON PIKE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:FEASTERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19053
Mailing Address - Country:US
Mailing Address - Phone:267-225-2975
Mailing Address - Fax:866-973-9701
Practice Address - Street 1:1200 BUSTLETON PIKE
Practice Address - Street 2:SUITE 9
Practice Address - City:FEASTERVILLE
Practice Address - State:PA
Practice Address - Zip Code:19053
Practice Address - Country:US
Practice Address - Phone:267-225-2975
Practice Address - Fax:866-973-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E41457Medicare UPIN