Provider Demographics
NPI:1346291614
Name:SHULTZ, THOMAS LAURIE (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LAURIE
Last Name:SHULTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:41 UNIVERSITY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-5522
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:240 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-750-2300
Practice Address - Fax:215-750-2315
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD019588E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30214727OtherKEYSTONE FIRST
PA4920329OtherCIGNA PA
PA5140141OtherAETNA
PA0022069000OtherKEYSTONE IBC
PA141643OtherHIGHMARK BLUE SHIELD
PAP011850OtherGATEWAY
PAP01193471OtherRAILROAD MEDICARE
PA0009140600005Medicaid
PA141643OtherHIGHMARK BLUE SHIELD
PAP01193471OtherRAILROAD MEDICARE