Healthcare Provider Details

I. General information

NPI: 1730147067
Provider Name (Legal Business Name): THOMAS J CIOTOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N VINE ST
HAZLETON PA
18201
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 570-454-2467
  • Fax: 570-455-2070
Mailing address:
  • Phone: 484-884-4500
  • Fax: 484-884-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD019396E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001122527-0003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier0011225270001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
IdentifierP00094194
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 4
Identifier080573
Identifier TypeOTHER
Identifier State
Identifier IssuerFIRST PRIORITY HEALTH
# 5
Identifier50005162
Identifier TypeOTHER
Identifier State
Identifier IssuerCAPITAL BLUE CROSS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: