Provider Demographics
NPI:1558369942
Name:COATS, THOMAS D (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:COATS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1244 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE E1
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-1743
Mailing Address - Country:US
Mailing Address - Phone:215-643-2730
Mailing Address - Fax:215-643-6677
Practice Address - Street 1:1244 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE E1
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-1743
Practice Address - Country:US
Practice Address - Phone:215-643-2730
Practice Address - Fax:215-643-6677
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD053603L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA790399DWVMedicare ID - Type Unspecified
G11822Medicare UPIN