Provider Demographics
NPI:1801010723
Name:PLUT, THOMAS W (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:PLUT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:401 YOUNG AVE
Practice Address - Street 2:SUITE 160 FRONT
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3128
Practice Address - Country:US
Practice Address - Phone:856-234-9006
Practice Address - Fax:856-234-9233
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB82093207QS0010X
NJ25MB08209300207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
112316C04Medicare PIN