Provider Demographics
NPI:1740249630
Name:MIDAS, THADDEUS MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:MICHAEL
Last Name:MIDAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 BRIDGE ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1800
Mailing Address - Country:US
Mailing Address - Phone:610-377-6155
Mailing Address - Fax:610-377-9765
Practice Address - Street 1:701 BRIDGE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1800
Practice Address - Country:US
Practice Address - Phone:610-377-6155
Practice Address - Fax:610-377-9765
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003455-L103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA818748OtherNORTHEAST BLUE CROSS BLUE SHIELD
PA4455111OtherAETNA
PA50008809OtherCAPITAL BLUE CROSS
PA402652Medicare ID - Type UnspecifiedPSYCHOLOGY