Provider Demographics
NPI:1447241682
Name:PEFF, THOMAS C (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:PEFF
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 1:8407 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1901
Mailing Address - Country:US
Mailing Address - Phone:215-722-3200
Mailing Address - Fax:215-725-0253
Practice Address - Street 1:8407 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-1901
Practice Address - Country:US
Practice Address - Phone:215-722-3200
Practice Address - Fax:215-725-0253
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034525E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010604700001Medicaid
B42069Medicare UPIN
464819Medicare ID - Type Unspecified
PA0758180001Medicare NSC