Provider Demographics
NPI:1356660963
Name:COMMANDER, THOMAS (PN045890L)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:COMMANDER
Suffix:
Gender:M
Credentials:PN045890L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6636 PERRY AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-4311
Mailing Address - Country:US
Mailing Address - Phone:610-734-1175
Mailing Address - Fax:
Practice Address - Street 1:6636 PERRY AVE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-4311
Practice Address - Country:US
Practice Address - Phone:610-734-1175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN045890L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse