Organization
IRA M. THAL, MD, PC
Active
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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