Provider Demographics
NPI:1609876333
Name:SIMONIAN, THOMAS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:SIMONIAN
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 1:201 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16550-0002
Mailing Address - Country:US
Mailing Address - Phone:814-877-6139
Mailing Address - Fax:814-877-6093
Practice Address - Street 1:201 STATE STREET
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-6139
Practice Address - Fax:814-877-6093
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039537E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01205054OtherNY MEDICAL ASSISTANCE
PA402687OtherBLUE SHIELD
PA0011807180001Medicaid
PA0898435OtherOH MEDICAL ASSISTANCE
WV1068885OtherW. VIRGINIA WORKERS COMP
PA00025983801OtherUNIVERA
PA1510447OtherGATEWAY
PA212681OtherUPMA
PA080096091OtherRR MEDICARE
PA843297OtherAETNA
PA96250OtherUNISON
PA080096091OtherRR MEDICARE
WV1068885OtherW. VIRGINIA WORKERS COMP