Provider Demographics
NPI:1336249853
Name:DELEHANTY, THOMAS JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAY
Last Name:DELEHANTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:250 PIERCE ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5149
Mailing Address - Country:US
Mailing Address - Phone:570-283-1107
Mailing Address - Fax:570-283-1089
Practice Address - Street 1:250 PIERCE ST
Practice Address - Street 2:SUITE 211
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5149
Practice Address - Country:US
Practice Address - Phone:570-283-1107
Practice Address - Fax:570-283-1089
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD022380E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001014074Medicaid
PA001014074Medicaid
PA188472DYVMedicare ID - Type Unspecified