Healthcare Provider Details

I. General information

NPI: 1801020441
Provider Name (Legal Business Name): RENEE THOLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S 9TH ST STE 402
PHILADELPHIA PA
19107-6810
US

IV. Provider business mailing address

211 S 9TH ST STE 402
PHILADELPHIA PA
19107-6810
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-0020
  • Fax:
Mailing address:
  • Phone: 215-955-0020
  • Fax: 215-503-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT194949
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD443946
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: