Provider Demographics
NPI:1689751729
Name:MCCLURE, THOMAS D (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:MCCLURE
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 1:514 PELLIS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4593
Mailing Address - Country:US
Mailing Address - Phone:724-832-8004
Mailing Address - Fax:724-837-1870
Practice Address - Street 1:514 PELLIS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4593
Practice Address - Country:US
Practice Address - Phone:724-832-8004
Practice Address - Fax:724-837-1870
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD008783E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B39177Medicare UPIN