Organization
THOMAS R. ELLENBERGER, JR MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS RICHARD ELLENBERGER JR. M.D. (PRESIDENT)
(814) 535-7885
Entity
Organization
Contact information
Practice address
321 MAIN ST STE 5D, JOHNSTOWN, PA 15901-1632
(814) 535-7885
(814) 535-7079
Mailing address
321 MAIN ST STE 5D, JOHNSTOWN, PA 15901-1632
(814) 535-7885
(814) 535-7079
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
MD018414E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006378450001
—
PA
01
—
027796
HIGHMARK
PA
01
—
0743755
UMWA
—
01
—
11978
UPMC HEALTH PLAN
PA
Enumeration date
03/20/2007
Last updated
09/27/2007
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