Provider Demographics
NPI:1336395003
Name:EASLEY, TOMMIE (MD)
Entity Type:Individual
Prefix:
First Name:TOMMIE
Middle Name:
Last Name:EASLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 W CHEW ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5549
Mailing Address - Country:US
Mailing Address - Phone:610-969-3500
Mailing Address - Fax:610-969-3605
Practice Address - Street 1:1730 W CHEW ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5549
Practice Address - Country:US
Practice Address - Phone:610-969-3500
Practice Address - Fax:610-969-3605
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT198239207Q00000X
OH35.128933208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine