MEDICARE: DR. THOMAS JEROME DEVLIN M.D.

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
1	207Q00000X	Family Medicine Physician	D0021488	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1377292	OTHER	WV	CIGNA

General Provider Information

NPI Number	:	1457469900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS JEROME DEVLIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 457
Second Line	:
City	:	BEAVER
State	:	PA
Zip	:	15009-0457
Country	:	US
Telephone Number	:	304-947-5500
Fax Number	:	304-947-5563

Provider Business Practice Location Address
First Line	:	783 WINCHESTER STREET
Second Line	:
City	:	PAW PAW
State	:	WV
Zip	:	25434-0002
Country	:	US
Telephone Number	:	304-947-5500
Fax Number	:	304-947-5563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	06/24/2017

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