Provider Demographics
NPI:1710985056
Name:TYMA, THOMAS ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALLEN
Last Name:TYMA
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 1:150 LAKE DR
Mailing Address - Street 2:STE 109
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8405
Mailing Address - Country:US
Mailing Address - Phone:724-935-0400
Mailing Address - Fax:724-935-5558
Practice Address - Street 1:150 LAKE DR
Practice Address - Street 2:STE 109
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8405
Practice Address - Country:US
Practice Address - Phone:724-935-0400
Practice Address - Fax:724-935-5558
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049451L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA15066500102Medicaid
660001299OtherRAILROAD MEDICARE
PA488397OtherBLUE SHIELD
PA488397JJ6Medicare PIN
TT488397Medicare ID - Type Unspecified
PA488397OtherBLUE SHIELD
660001299OtherRAILROAD MEDICARE
F49531Medicare UPIN