Healthcare Provider Details

I. General information

NPI: 1609876333
Provider Name (Legal Business Name): THOMAS MICHAEL SIMONIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STATE STREET
ERIE PA
16550-0002
US

IV. Provider business mailing address

201 STATE STREET
ERIE PA
16550-0002
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-6139
  • Fax: 814-877-6093
Mailing address:
  • Phone: 814-877-6139
  • Fax: 814-877-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD039537E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: