Provider Demographics
NPI:1639363211
Name:THOMAS J ALLARDYCE MD PC
Entity type:Organization
Organization Name:THOMAS J ALLARDYCE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALLARDYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-824-2225
Mailing Address - Street 1:150 MUNDY ST
Mailing Address - Street 2:MAC1
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6830
Mailing Address - Country:US
Mailing Address - Phone:570-824-2225
Mailing Address - Fax:570-824-6240
Practice Address - Street 1:150 MUNDY ST
Practice Address - Street 2:MAC1
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6830
Practice Address - Country:US
Practice Address - Phone:570-824-2225
Practice Address - Fax:570-824-6240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA048075L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015707220004Medicaid
PA729472OtherHIGHMARK BLUE SHIELD
PA729472OtherHIGHMARK BLUE SHIELD
PAG22739Medicare UPIN