Provider Demographics
NPI:1033679691
Name:THAL, KARISSA (MD)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:THAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:141 MEDICAL PARK LN
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-9112
Mailing Address - Country:US
Mailing Address - Phone:814-355-7322
Mailing Address - Fax:814-355-9604
Practice Address - Street 1:141 MEDICAL PARK LN
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-9112
Practice Address - Country:US
Practice Address - Phone:814-355-7322
Practice Address - Fax:814-355-9604
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD477151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine