Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | DA031803 | PA |
N | 1223G0001X | General Practice | 3504 | SC |
N | 213EG0000X | General Practice | 3504 | SC |
N | 1223G0001X | General Practice | DS041643 | PA |
N | 213EG0000X | General Practice | DS041643 | PA |
NPI | 1174580815 |
---|---|
Provider Name | Dr. Thomas Monroe Hendley III |
First Address | Pittsburgh, PA 15220-3510 |
Second Address | Pittsburgh, PA 15220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 05/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ZA9857 | (05) | SC |