Provider Demographics
NPI:1548226764
Name:THANE, THANE TOE (MD)
Entity Type:Individual
Prefix:
First Name:THANE
Middle Name:TOE
Last Name:THANE
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 1:25 PENNCRAFT AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-5600
Mailing Address - Country:US
Mailing Address - Phone:717-263-1383
Mailing Address - Fax:717-263-7434
Practice Address - Street 1:25 PENNCRAFT AVE
Practice Address - Street 2:SUITE E
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-5600
Practice Address - Country:US
Practice Address - Phone:717-263-1383
Practice Address - Fax:717-263-7434
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026557E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03260201OtherCAPITAL BLUE CROSS
PA0008984940002Medicaid
PATH78110OtherHIGHMARK
NY02667045Medicaid
PA03260201OtherCAPITAL BLUE CROSS
PATH78110OtherHIGHMARK