Provider Demographics
NPI:1164424347
Name:O'GRADY, THOMAS JOHN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:O'GRADY
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 1:1650 HUNTINGTON PIKE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046
Mailing Address - Country:US
Mailing Address - Phone:215-938-3413
Mailing Address - Fax:215-938-3422
Practice Address - Street 1:1648 HUNTINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046
Practice Address - Country:US
Practice Address - Phone:215-938-3413
Practice Address - Fax:215-938-3422
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-039507-E174400000X
PAMD039507E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1195962Medicare ID - Type Unspecified
PA597479Medicare ID - Type Unspecified
E52969Medicare UPIN