Provider Demographics
NPI:1205890407
Name:FESSLER, THOMAS
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:FESSLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 STATE ST STE 103
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 PEACH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1423
Practice Address - Country:US
Practice Address - Phone:814-454-8287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040025E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011837380001Medicaid
PA000565710OtherHIGHMARK
200008555OtherRAILROAD MEDICARE
PA0011837380001Medicaid
1183738Medicare PIN
200008555OtherRAILROAD MEDICARE
PA565710D3RMedicare PIN