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General NPI Number Information
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NPI Number | 1245778786
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Entity Type | Organization
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Legal Business Name | IRA M THAL, MD, PC
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Dates
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Enumeration Date | 02/04/2017
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Last Update Date | 02/04/2017
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Provider Practice Location Address
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Address Line | 1615 E BOOT RD
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City | WEST CHESTER
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State | PA
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Zip | 19380-6001
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Country | US
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Telephone | 610-692-7766
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Fax | 610-918-9065
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Provider Business Mailing Address
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Address Line | PO BOX 376
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-0376
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Country | US
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Telephone | 610-692-7766
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Fax | 610-918-9065
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Authorized Official
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Title or Position | OWNER
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Name | IRA MERVYN THAL
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Credential | MD
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Telephone | 610-692-7766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD0449987L
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License Number State | PA
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