Provider Demographics
NPI:1154438059
Name:MCCANN, TOMI J (MD)
Entity type:Individual
Prefix:
First Name:TOMI
Middle Name:J
Last Name:MCCANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 BALTIMORE PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1365
Mailing Address - Country:US
Mailing Address - Phone:484-227-7790
Mailing Address - Fax:484-227-7791
Practice Address - Street 1:1020 BALTIMORE PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1365
Practice Address - Country:US
Practice Address - Phone:484-227-7790
Practice Address - Fax:484-227-7791
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031125E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC29858Medicare UPIN
PA098323HK1Medicare PIN
PA0016312560006Medicaid