Provider Demographics
NPI:1528369634
Name:THOMAS OPERCHAL MD PA
Entity Type:Organization
Organization Name:THOMAS OPERCHAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:OPERCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-743-7824
Mailing Address - Street 1:2375 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2231
Mailing Address - Country:US
Mailing Address - Phone:305-743-7824
Mailing Address - Fax:305-743-8815
Practice Address - Street 1:2375 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2231
Practice Address - Country:US
Practice Address - Phone:305-743-7824
Practice Address - Fax:305-743-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40166174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54901Medicare UPIN