Provider Demographics
NPI:1073552840
Name:RENALDO, THOMAS J (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:RENALDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:1255 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 3200
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6256
Practice Address - Country:US
Practice Address - Phone:610-402-5623
Practice Address - Fax:610-402-1675
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005407L207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0040725000OtherKEYSTONE EAST
PA50004441OtherCAPITAL BLUE CROSS
PA138086OtherHIGHMARK BLUE SHIELD
PA80095184OtherRAILROAD MEDICARE
PA80095184OtherRAILROAD MEDICARE
PAB38828Medicare UPIN