Healthcare Provider Details

I. General information

NPI: 1588634927
Provider Name (Legal Business Name): THOMAS L MINORA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 PITTSTON AVE
SCRANTON PA
18505-3238
US

IV. Provider business mailing address

2232 PITTSTON AVE
SCRANTON PA
18505-4556
US

V. Phone/Fax

Practice location:
  • Phone: 570-969-1669
  • Fax:
Mailing address:
  • Phone: 570-969-6327
  • Fax: 570-969-6313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD034172E
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier001121584
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: