Provider Demographics
NPI:1811960305
Name:RUTH, THOMAS A (PA-C)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:RUTH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 2ND AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3600
Mailing Address - Country:US
Mailing Address - Phone:610-454-7750
Mailing Address - Fax:610-454-1367
Practice Address - Street 1:555 2ND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3600
Practice Address - Country:US
Practice Address - Phone:610-454-7750
Practice Address - Fax:610-454-1367
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000447L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S49279Medicare UPIN