Individual
GRADY THOMAS EGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
120 PINE ST, TAMAQUA, PA 18252-1409
(484) 526-1735
Mailing address
120 PINE ST, TAMAQUA, PA 18252-1409
(484) 526-1735
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA066436
PA
363A00000X
Physician Assistant
OA007184
PA
363AS0400X
Surgical Physician Assistant
MA066436
PA
363AS0400X
Surgical Physician Assistant
OA007184
PA
Other
Enumeration date
01/20/2025
Last updated
02/14/2025
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