Provider Demographics
NPI:1013904259
Name:TON-THAT, TONY T (MD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:T
Last Name:TON-THAT
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 1:675 GOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2426
Mailing Address - Country:US
Mailing Address - Phone:717-406-3000
Mailing Address - Fax:717-394-7501
Practice Address - Street 1:2100 HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3197
Practice Address - Fax:717-544-3171
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD495582081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001029850001Medicaid
H42078Medicare UPIN
059895FX1Medicare ID - Type Unspecified