Provider Demographics
NPI:1609828912
Name:EBERLE, THOMAS MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:EBERLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 WILDWOOD RD EXT
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101
Mailing Address - Country:US
Mailing Address - Phone:412-486-3622
Mailing Address - Fax:412-486-6123
Practice Address - Street 1:3154 WILDWOOD RD EXT
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101
Practice Address - Country:US
Practice Address - Phone:412-486-3622
Practice Address - Fax:412-486-6123
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002276L103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
O29916Medicare UPIN