Individual
IRA MERVYN THAL
Active
Individual
IRA MERVYN THAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
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 PPO
—
01
—
810561286
CIGNA
—
01
—
TH1413362
BLUE SHIELD
—
Enumeration date
06/27/2006
Last updated
09/12/2024
Update your record
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