Individual
IRA MERVYN THAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1361 E BOOT RD, WEST CHESTER, PA 19380-5934
(484) 653-1416
(484) 653-1414
Mailing address
PO BOX 376, NEWTOWN SQUARE, PA 19073-0376
(484) 653-1416
(484) 653-1414
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
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