Provider Demographics
NPI:1972535334
Name:MCCROREY, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MCCROREY
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 1:2385 RIDGE FIELD TRL
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-6804
Mailing Address - Country:US
Mailing Address - Phone:775-624-4222
Mailing Address - Fax:
Practice Address - Street 1:10685 PROFESSIONAL CIR STE B
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5843
Practice Address - Country:US
Practice Address - Phone:775-329-3100
Practice Address - Fax:775-329-3199
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14501208600000X
WI48621208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00263362OtherRR MEDICARE
P00263362OtherRR MEDICARE
I45428Medicare UPIN