# THOMAS R. ELLENBERGER, JR MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942325592
- **Authorized official:** DR. THOMAS RICHARD ELLENBERGER JR. M.D. (PRESIDENT)
- **Authorized official phone:** (814) 535-7885

## Contact information

- **Practice address:** 321 MAIN ST STE 5D, JOHNSTOWN, PA 15901-1632
- **Practice address phone:** (814) 535-7885
- **Practice address fax:** (814) 535-7079
- **Mailing address:** 321 MAIN ST STE 5D, JOHNSTOWN, PA 15901-1632
- **Mailing address phone:** (814) 535-7885
- **Mailing address fax:** (814) 535-7079

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | MD018414E | PA | Yes |

## Other

- **Enumeration date:** 03/20/2007
- **Last updated:** 09/27/2007