Provider Demographics
NPI:1194992008
Name:TONI JO PARMELEE, D.O., PC
Entity type:Organization
Organization Name:TONI JO PARMELEE, D.O., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TONI JO
Authorized Official - Middle Name:
Authorized Official - Last Name:PARMELEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-613-9900
Mailing Address - Street 1:214 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-1619
Mailing Address - Country:US
Mailing Address - Phone:570-613-9900
Mailing Address - Fax:570-613-9902
Practice Address - Street 1:214 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-1619
Practice Address - Country:US
Practice Address - Phone:570-613-9900
Practice Address - Fax:570-613-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006766L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012310580015Medicaid
PAE38342OtherUPIN
PA580449Medicare PIN