Provider Demographics
NPI:1831199934
Name:ALBERT, THOMAS KEITH (DPM)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:KEITH
Last Name:ALBERT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 OAK LN
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-9035
Mailing Address - Country:US
Mailing Address - Phone:610-374-3684
Mailing Address - Fax:610-374-3227
Practice Address - Street 1:200 READING AVE
Practice Address - Street 2:STE 101
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1140
Practice Address - Country:US
Practice Address - Phone:610-374-3684
Practice Address - Fax:610-374-3227
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001706-L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA646284OtherBLUESHIELD
PA646284OtherBLUESHIELD
T29520Medicare UPIN