Provider Demographics
NPI:1649374760
Name:THOMAS H GULICK MD PC
Entity type:Organization
Organization Name:THOMAS H GULICK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:GULICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-258-9000
Mailing Address - Street 1:3735 NAZARETH ROAD
Mailing Address - Street 2:NORTHWOOD MEDICAL ARTS BLDG STE 202
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042
Mailing Address - Country:US
Mailing Address - Phone:610-258-9000
Mailing Address - Fax:610-258-9702
Practice Address - Street 1:3735 NAZARETH ROAD
Practice Address - Street 2:NORTHWOOD MEDICAL ARTS BLDG STE 202
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042
Practice Address - Country:US
Practice Address - Phone:610-258-9000
Practice Address - Fax:610-258-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014274E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU105563Medicare ID - Type Unspecified
B36628Medicare UPIN