Provider Demographics
NPI:1679509624
Name:GULICK, THOMAS HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:HOWARD
Last Name:GULICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:206 E BROWN ST
Mailing Address - Street 2:POCONO HEALTHCARE MANAGEMENT-PROFESSIONAL CENTER
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-420-4951
Mailing Address - Fax:570-476-3754
Practice Address - Street 1:175 E BROWN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3098
Practice Address - Country:US
Practice Address - Phone:570-424-7390
Practice Address - Fax:570-424-7395
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD014274E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA340012004OtherRAILROAD MEDICARE
PA814179OtherAETNA
PA076420OtherFIRST PRIORITY HLTH
PA340012004OtherRAILROAD MEDICARE
PA119001Medicare ID - Type Unspecified