Provider Demographics
NPI:1659302206
Name:BYRON, THOMAS W (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:BYRON
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 1:2800 MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1569
Mailing Address - Country:US
Mailing Address - Phone:570-675-7637
Mailing Address - Fax:570-675-7882
Practice Address - Street 1:2800 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1569
Practice Address - Country:US
Practice Address - Phone:570-675-7637
Practice Address - Fax:570-675-7882
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024634E207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000407060OtherBLUE SHIELD
PA072017OtherFIRST PRIORITY
PA0007769380002Medicaid
PAC33538Medicare UPIN
PA000407060OtherBLUE SHIELD