Healthcare Provider Details

I. General information

NPI: 1962408534
Provider Name (Legal Business Name): THOMAS RICHARD ZIEGLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4572 SOUTHERN DRIVE
ERIE PA
16506-1536
US

IV. Provider business mailing address

P.O BOX 3093
ERIE PA
16508-0093
US

V. Phone/Fax

Practice location:
  • Phone: 814-824-9410
  • Fax: 814-868-8170
Mailing address:
  • Phone: 814-990-0873
  • Fax: 814-868-8170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD038051E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMD038051E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: