Healthcare Provider Details

I. General information

NPI: 1972583995
Provider Name (Legal Business Name): THOMAS G MAJERNICK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 RIVER ST
OLYPHANT PA
18447-1475
US

IV. Provider business mailing address

221 RIVER ST
OLYPHANT PA
18447-1475
US

V. Phone/Fax

Practice location:
  • Phone: 570-383-3636
  • Fax:
Mailing address:
  • Phone: 570-383-3636
  • Fax: 570-383-3638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS004924L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: