Provider Demographics
NPI:1275535205
Name:HANLON, THOMAS W (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:HANLON
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:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-0070
Mailing Address - Country:US
Mailing Address - Phone:570-861-8200
Mailing Address - Fax:570-861-8205
Practice Address - Street 1:631 AIRPORT ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202
Practice Address - Country:US
Practice Address - Phone:570-861-8200
Practice Address - Fax:570-861-8205
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044497L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012583000010Medicaid
PA0012583000011Medicaid
PA682443Medicare ID - Type Unspecified
PA0012583000010Medicaid