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General NPI Number Information
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NPI Number | 1942325592
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Entity Type | Organization
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Legal Business Name | THOMAS R. ELLENBERGER, JR MD PC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 321 MAIN ST STE 5D
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City | JOHNSTOWN
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State | PA
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Zip | 15901-1632
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Country | US
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Telephone | 814-535-7885
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Fax | 814-535-7079
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Provider Business Mailing Address
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Address Line | 321 MAIN ST STE 5D
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City | JOHNSTOWN
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State | PA
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Zip | 15901-1632
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Country | US
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Telephone | 814-535-7885
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Fax | 814-535-7079
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS RICHARD ELLENBERGER JR.
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Credential | M.D.
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Telephone | 814-535-7885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD018414E
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License Number State | PA
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