Provider Demographics
NPI:1457469900
Name:DEVLIN, THOMAS JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JEROME
Last Name:DEVLIN
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 457
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-0457
Mailing Address - Country:US
Mailing Address - Phone:304-947-5500
Mailing Address - Fax:304-947-5563
Practice Address - Street 1:783 WINCHESTER STREET
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:WV
Practice Address - Zip Code:25434-0002
Practice Address - Country:US
Practice Address - Phone:304-947-5500
Practice Address - Fax:304-947-5563
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2017-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0021488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD186511100Medicaid
WV1377292OtherCIGNA
MD2797Medicare ID - Type Unspecified
MD186511100Medicaid