Healthcare Provider Details

I. General information

NPI: 1609848696
Provider Name (Legal Business Name): THOMAS J MCDONALD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

IV. Provider business mailing address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

V. Phone/Fax

Practice location:
  • Phone: 570-888-5858
  • Fax:
Mailing address:
  • Phone: 570-888-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD032268E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number179149-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100014271
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRR MEDICARE PIN
# 2
IdentifierCC9269
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRR MEDICARE GROUP
# 3
Identifier01131704
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 4
IdentifierGU616091
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPA MEDICARE GROUP
# 5
IdentifierCC8362
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerRR MEDICARE GROUP
# 6
Identifier0010401180002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 7
IdentifierP00315704
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerRR MEDICARE PIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: