Provider Demographics
NPI:1679597355
Name:TACHOVSKY, THOMAS J (MD, FACS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:TACHOVSKY
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OSTRUM ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:610-954-2140
Mailing Address - Fax:610-954-6055
Practice Address - Street 1:801 OSTRUM ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1000
Practice Address - Country:US
Practice Address - Phone:610-954-2140
Practice Address - Fax:610-954-6055
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD006996E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000982383Medicaid
PAB33217Medicare UPIN
PA000982383Medicaid