Provider Demographics
NPI:1508852930
Name:WALDEN, THOMAS BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BRUCE
Last Name:WALDEN
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 1:3729 EASTON NAZARETH HWY
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-8344
Mailing Address - Country:US
Mailing Address - Phone:610-253-3333
Mailing Address - Fax:610-258-8189
Practice Address - Street 1:3729 EASTON NAZARETH HWY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8344
Practice Address - Country:US
Practice Address - Phone:610-253-3333
Practice Address - Fax:610-258-8189
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021534E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007331530005Medicaid
PAC31377Medicare UPIN
PA136732Medicare ID - Type Unspecified