Organization
IRA M. THAL, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IRA MERVYN THAL MD (PRESIDENT)
(610) 647-5544
Entity
Organization
Contact information
Practice address
255 W LANCASTER AVE, SUITE 202, PAOLI, PA 19301-1763
(610) 647-5544
(610) 647-5545
Mailing address
255 W LANCASTER AVE, SUITE 202, PAOLI, PA 19301-1763
(610) 647-5544
(610) 647-5545
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD044987L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0560080000
KEYSTONE
—
01
—
110241724
RAILROAD MEDICARE
—
01
—
1413362
PERSONAL CHOICE
—
01
—
4339125
AETNA
—
01
—
TH1413362
BLUE SHIELD
—
Enumeration date
11/06/2007
Last updated
04/20/2008
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