Provider Demographics
NPI:1659363935
Name:LJUNGMAN, THOMAS N (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:N
Last Name:LJUNGMAN
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 1:115 S SECOND ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:PA
Mailing Address - Zip Code:15089-1357
Mailing Address - Country:US
Mailing Address - Phone:724-872-5252
Mailing Address - Fax:724-872-5501
Practice Address - Street 1:115 S SECOND ST
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:PA
Practice Address - Zip Code:15089-1357
Practice Address - Country:US
Practice Address - Phone:724-872-5252
Practice Address - Fax:724-872-5501
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041300L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012950000005Medicaid
719544Medicare ID - Type Unspecified
PA0012950000005Medicaid