Provider Demographics
NPI:1033188610
Name:URSCHEL, THOMAS P (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:URSCHEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:CLARENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14429-0073
Mailing Address - Country:US
Mailing Address - Phone:585-638-5544
Mailing Address - Fax:585-768-8165
Practice Address - Street 1:639 EXCHANGE STREET RD
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-9647
Practice Address - Country:US
Practice Address - Phone:585-591-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004776363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS36716Medicare UPIN