Provider Demographics
NPI:1225002801
Name:THOMAS, KURT K (DO)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:K
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 PENN ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1928
Mailing Address - Country:US
Mailing Address - Phone:717-637-9219
Mailing Address - Fax:717-637-9715
Practice Address - Street 1:136 PENN ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1928
Practice Address - Country:US
Practice Address - Phone:717-637-9219
Practice Address - Fax:717-637-9715
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006803-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080025995OtherRAILROAD MEDICARE
PA824762OtherPENNSYLVANIA BLUE SHIELD
PA01987101OtherCAPITAL BLUE CROSS
PA01987101OtherCAPITAL BLUE CROSS
PAE75420Medicare UPIN