Provider Demographics
NPI:1629093877
Name:RADECKI, THOMAS EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:RADECKI
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 1:238 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-1043
Mailing Address - Country:US
Mailing Address - Phone:814-226-4909
Mailing Address - Fax:814-227-2176
Practice Address - Street 1:238 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1043
Practice Address - Country:US
Practice Address - Phone:814-226-4909
Practice Address - Fax:814-227-2176
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015591E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014336910001Medicaid
PAC45566Medicare UPIN
PA1014336910001Medicaid