Provider Demographics
NPI:1396925467
Name:IRA M. THAL, MD, PC
Entity type:Organization
Organization Name:IRA M. THAL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:MERVYN
Authorized Official - Last Name:THAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-647-5544
Mailing Address - Street 1:255 W LANCASTER AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1763
Mailing Address - Country:US
Mailing Address - Phone:610-647-5544
Mailing Address - Fax:610-647-5545
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:610-647-5544
Practice Address - Fax:610-647-5545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044987L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110241724OtherRAILROAD MEDICARE
0560080000OtherKEYSTONE
TH1413362OtherBLUE SHIELD
4339125OtherAETNA
1413362OtherPERSONAL CHOICE
F27239Medicare UPIN
=========OtherCIGNA