Provider Demographics
NPI:1952524191
Name:NEILL, THOMAS HENRY (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HENRY
Last Name:NEILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 BRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:WEISSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18235-0000
Mailing Address - Country:US
Mailing Address - Phone:610-379-9930
Mailing Address - Fax:610-379-9307
Practice Address - Street 1:413 BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:WEISSPORT
Practice Address - State:PA
Practice Address - Zip Code:18235-0000
Practice Address - Country:US
Practice Address - Phone:610-379-9304
Practice Address - Fax:610-379-9307
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005173L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011098660006Medicaid
PA1007305480004Medicaid
PA0011098660012Medicaid
B41171Medicare UPIN
PA0011098660006Medicaid