Healthcare Provider Details

I. General information

NPI: 1881621878
Provider Name (Legal Business Name): IRA MERVYN THAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 E BOOT RD
WEST CHESTER PA
19380-5934
US

IV. Provider business mailing address

PO BOX 376
NEWTOWN SQUARE PA
19073-0376
US

V. Phone/Fax

Practice location:
  • Phone: 484-653-1416
  • Fax: 484-653-1414
Mailing address:
  • Phone: 484-653-1416
  • Fax: 484-653-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD044987L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: