Provider Demographics
NPI:1760425581
Name:BURKHOLDER, THOMAS O (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:O
Last Name:BURKHOLDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 N 17TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104
Mailing Address - Country:US
Mailing Address - Phone:610-433-0450
Mailing Address - Fax:610-433-4655
Practice Address - Street 1:400 N 17TH ST
Practice Address - Street 2:STE 101
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:610-433-0450
Practice Address - Fax:610-433-4655
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017300E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0596288Medicaid
PA0596288Medicaid
B39981Medicare UPIN