Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | MD49558 | PA |
NPI | 1013904259 |
---|---|
Provider Name | Tony T Ton-That |
First Address | Lancaster, PA 17601-2426 |
Second Address | Lancaster, PA 17601-2644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001029850001 | (05) | PA |
H42078 | (02) |