Provider Demographics
NPI:1922098151
Name:TOMACRUZ, LUIS P (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:P
Last Name:TOMACRUZ
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 1:835 HOSPITAL ROAD
Mailing Address - Street 2:PO BOX 788
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-0788
Mailing Address - Country:US
Mailing Address - Phone:724-357-7009
Mailing Address - Fax:724-357-7414
Practice Address - Street 1:835 HOSPITAL ROAD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-0788
Practice Address - Country:US
Practice Address - Phone:724-357-7121
Practice Address - Fax:724-357-7479
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056605L207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA252062OtherUPMC
PA0015364710008Medicaid
PA000777968OtherBLUE SHIELD
PA777968GU9Medicare ID - Type Unspecified
PA0015364710008Medicaid