Healthcare Provider Details

I. General information

NPI: 1164424347
Provider Name (Legal Business Name): THOMAS JOHN O'GRADY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 HUNTINGTON PIKE
MEADOWBROOK PA
19046
US

IV. Provider business mailing address

1650 HUNTINGTON PIKE SUITE 313
MEADOWBROOK PA
19046
US

V. Phone/Fax

Practice location:
  • Phone: 215-938-3413
  • Fax: 215-938-3422
Mailing address:
  • Phone: 215-938-3413
  • Fax: 215-938-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD-039507-E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD039507E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: