Provider Demographics
NPI:1881647469
Name:PANGBURN, THOMAS LM (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LM
Last Name:PANGBURN
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 1:1 SCAIFE RD
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-9344
Mailing Address - Country:US
Mailing Address - Phone:412-741-4801
Mailing Address - Fax:
Practice Address - Street 1:1 SCAIFE RD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-9344
Practice Address - Country:US
Practice Address - Phone:412-741-4801
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056686L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG24398Medicare UPIN