Provider Demographics
NPI:1558461160
Name:FORKER, THOMAS STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STEPHEN
Last Name:FORKER
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 1:280 DUNKLEBERGER RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-9292
Mailing Address - Country:US
Mailing Address - Phone:570-321-1178
Mailing Address - Fax:
Practice Address - Street 1:280 DUNKLEBERGER RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-9292
Practice Address - Country:US
Practice Address - Phone:570-321-1178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021932E207PE0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA917990OtherFIRST PRIORITY HEALTH
PA13221OtherGEISINGER HEALTH PLAN
PAB36219OtherHEALTH AMERICA
PA917990OtherFIRST PRIORITY HEALTH
PAB36219OtherHEALTH AMERICA
PA930030931Medicare ID - Type UnspecifiedRR MEDICARE