Provider Demographics
NPI:1073640678
Name:NOLLER, THOMAS HANZ (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HANZ
Last Name:NOLLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 PENN ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19602-1096
Mailing Address - Country:US
Mailing Address - Phone:610-375-3000
Mailing Address - Fax:610-898-1149
Practice Address - Street 1:526 PENN ST
Practice Address - Street 2:STE 2
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19602-1097
Practice Address - Country:US
Practice Address - Phone:610-375-3000
Practice Address - Fax:610-898-1149
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034593E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20029112Medicaid
PA20029112Medicaid
PA444432Medicare ID - Type Unspecified