| Ira M. Thal, Md, Pc | |
|
255 W Lancaster Ave Suite 202 Paoli PA 19301-1763 | |
| (610) 647-5544 | |
| (610) 647-5545 |
| Full Name | Ira M. Thal, Md, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 255 W Lancaster Ave, Paoli, Pennsylvania |
| Authorized Official Name and Position | Ira Mervyn Thal (PRESIDENT) |
| Authorized Official Contact | 6106475544 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ira M. Thal, Md, Pc 255 W Lancaster Ave Suite 202 Paoli PA 19301-1763 Ph: (610) 647-5544 | Ira M. Thal, Md, Pc 255 W Lancaster Ave Suite 202 Paoli PA 19301-1763 Ph: (610) 647-5544 |
| NPI Number | 1396925467 |
|---|---|
| Provider Enumeration Date | 11/06/2007 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 3678544921 |
|---|---|
| Medicare Enrollment ID | O20040802001184 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396925467 | NPI | - | NPPES |
| 0560080000 | Other | KEYSTONE | |
| TH1413362 | Other | BLUE SHIELD | |
| 4339125 | Other | AETNA | |
| 1413362 | Other | PERSONAL CHOICE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD044987L (Pennsylvania) | Primary |
| Provider Name | Ira Mervyn Thal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881621878 PECOS PAC ID: 8123099454 Enrollment ID: I20040802001006 |
| Provider Name | Wendy S Thal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518037670 PECOS PAC ID: 2466496476 Enrollment ID: I20050610000377 |
| Provider Name | Jennifer F Ceglia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871807511 PECOS PAC ID: 7113244906 Enrollment ID: I20150316000112 |
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Pennsylvania Physicians Services, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 209 W Lancaster Ave, Paoli, PA 19301 Phone: 610-644-2382 Fax: 610-644-7517 | |
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