Provider Demographics
NPI:1881668879
Name:MICHAELSON, THOMAS ERIK (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ERIK
Last Name:MICHAELSON
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:INFECTIOUS DISEASES ASSOCIATES, P.C.
Mailing Address - Street 2:729 GROVE AVE. SUITE 4
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-6008
Mailing Address - Country:US
Mailing Address - Phone:215-355-9634
Mailing Address - Fax:215-357-7540
Practice Address - Street 1:INFECTIOUS DISEASES ASSOCIATES PC
Practice Address - Street 2:729 GROVE AVE UNIT 4
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-6008
Practice Address - Country:US
Practice Address - Phone:215-355-9634
Practice Address - Fax:215-357-7540
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062751L207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017584150001Medicaid
PA026336FMUMedicare PIN
PAG90792Medicare UPIN