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NPI Code Detail

MEDICARE: DR. MANJU MARY THOMAS MD

MEDICARE: DR. MANJU MARY THOMAS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianMD426912PA

General Provider Information

NPI Number : 1013998897
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MANJU MARY THOMAS MD
Provider Business Mailing Address
First Line : 5 S WASHINGTON AVE
Second Line :
City : JERMYN
State : PA
Zip : 18433-1121
Country : US
Telephone Number : 570-230-0019
Fax Number : 610-638-0757
Provider Business Practice Location Address
First Line : 5 S WASHINGTON AVE
Second Line :
City : JERMYN
State : PA
Zip : 18433-1121
Country : US
Telephone Number : 570-230-0019
Fax Number : 610-638-0757
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 10/04/2023

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