MEDICARE: THOMAS N LJUNGMAN 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
1	207Q00000X	Family Medicine Physician	MD041300L	PA

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

General Provider Information

NPI Number	:	1659363935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS N LJUNGMAN MD

Provider Business Mailing Address
First Line	:	115 S SECOND ST
Second Line	:
City	:	WEST NEWTON
State	:	PA
Zip	:	15089-1357
Country	:	US
Telephone Number	:	724-872-5252
Fax Number	:	724-872-5501

Provider Business Practice Location Address
First Line	:	115 S SECOND ST
Second Line	:
City	:	WEST NEWTON
State	:	PA
Zip	:	15089-1357
Country	:	US
Telephone Number	:	724-872-5252
Fax Number	:	724-872-5501

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	11/05/2009

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