Provider Demographics
NPI:1093735789
Name:WILLCOX, THOMAS O (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:O
Last Name:WILLCOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:925 CHESTNUT STREET
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4204
Mailing Address - Country:US
Mailing Address - Phone:215-955-6760
Mailing Address - Fax:215-923-4532
Practice Address - Street 1:925 CHESTNUT ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4204
Practice Address - Country:US
Practice Address - Phone:215-955-6760
Practice Address - Fax:215-923-4532
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-042070-E207YX0007X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5599903Medicaid
PA001421099Medicaid
PA744103Medicare PIN