Provider Demographics
NPI:1235153305
Name:KAMINSKI, THOMAS NICK (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:NICK
Last Name:KAMINSKI
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 1:1 BRADDOCK ROAD AVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1458
Mailing Address - Country:US
Mailing Address - Phone:724-547-4536
Mailing Address - Fax:724-547-3799
Practice Address - Street 1:1 BRADDOCK ROAD AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1458
Practice Address - Country:US
Practice Address - Phone:724-547-4536
Practice Address - Fax:724-547-3799
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037152L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0655155Medicaid
093866E85Medicare ID - Type UnspecifiedMEDICARE
PA0655155Medicaid