Healthcare Provider Details

I. General information

NPI: 1922098151
Provider Name (Legal Business Name): LUIS P TOMACRUZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 05/16/2020
Certification Date: 05/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 HOSPITAL ROAD EMERGENCY DEPARTMENT
INDIANA PA
15701-0788
US

IV. Provider business mailing address

835 HOSPITAL ROAD PO BOX 788
INDIANA PA
15701-0788
US

V. Phone/Fax

Practice location:
  • Phone: 724-357-7121
  • Fax: 724-357-7479
Mailing address:
  • Phone: 724-357-7009
  • Fax: 724-357-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD056605L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD056605L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: