Provider Demographics
NPI:1821095548
Name:RYSCAVAGE, THOMAS STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:STEPHEN
Last Name:RYSCAVAGE
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 1:2200 S GEORGE ST
Mailing Address - Street 2:SUITE W-2
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4594
Mailing Address - Country:US
Mailing Address - Phone:717-741-4653
Mailing Address - Fax:717-741-6803
Practice Address - Street 1:2200 S GEORGE ST
Practice Address - Street 2:SUITE W-2
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4594
Practice Address - Country:US
Practice Address - Phone:717-741-4653
Practice Address - Fax:717-741-6803
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036084L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB36177Medicare UPIN
PARY094295Medicare ID - Type Unspecified