Healthcare Provider Details

I. General information

NPI: 1114914447
Provider Name (Legal Business Name): THOMAS ALLARDYCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S RIVER ST
PLAINS PA
18705-1137
US

IV. Provider business mailing address

220 S RIVER ST
PLAINS PA
18705-1137
US

V. Phone/Fax

Practice location:
  • Phone: 570-826-1555
  • Fax: 570-822-4445
Mailing address:
  • Phone: 570-826-1555
  • Fax: 570-822-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number048075L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: