Healthcare Provider Details

I. General information

NPI: 1013904259
Provider Name (Legal Business Name): TONY T TON-THAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 HARRISBURG PIKE
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

675 GOOD DR
LANCASTER PA
17601-2426
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3197
  • Fax: 717-544-3171
Mailing address:
  • Phone: 717-406-3000
  • Fax: 717-394-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD49558
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: