Healthcare Provider Details

I. General information

NPI: 1518987098
Provider Name (Legal Business Name): THOMAS JOSEPH FIUME M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 WYOMING AVE
KINGSTON PA
18704-3721
US

IV. Provider business mailing address

PO BOX 82
LAKE ARIEL PA
18436-0082
US

V. Phone/Fax

Practice location:
  • Phone: 570-552-3881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD030870E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: