Provider Demographics
NPI:1245778786
Name:IRA M THAL, MD, PC
Entity Type:Organization
Organization Name:IRA M THAL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:MERVYN
Authorized Official - Last Name:THAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-692-7766
Mailing Address - Street 1:PO BOX 376
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-0376
Mailing Address - Country:US
Mailing Address - Phone:610-692-7766
Mailing Address - Fax:610-918-9065
Practice Address - Street 1:1615 E BOOT RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-6001
Practice Address - Country:US
Practice Address - Phone:610-692-7766
Practice Address - Fax:610-918-9065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-04
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0449987L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty