Healthcare Provider Details
I. General information
NPI: 1104896364
Provider Name (Legal Business Name): ARTHUR DUTTON THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 01/23/2006
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1145 BOWER HILL RD STE 105
PITTSBURGH PA
15243-1346
US
IV. Provider business mailing address
737 PINOAK RD
PITTSBURGH PA
15243-1154
US
V. Phone/Fax
- Phone: 412-579-6194
- Fax: 412-572-6195
- Phone: 412-661-3400
- Fax: 412-661-5885
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208800000X |
| Taxonomy | Urology Physician |
| License Number | 22108 |
| License Number State | WV |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208800000X |
| Taxonomy | Urology Physician |
| License Number | MD425830 |
| License Number State | PA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: