Provider Demographics
NPI:1316923345
Name:GIOVINAZZO, THOMAS D (PA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:GIOVINAZZO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1555 W STREET RD
Mailing Address - Street 2:STE. 302
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-3100
Mailing Address - Country:US
Mailing Address - Phone:215-293-9560
Mailing Address - Fax:215-293-9560
Practice Address - Street 1:824 MAIN ST
Practice Address - Street 2:STE. 302
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4478
Practice Address - Country:US
Practice Address - Phone:610-983-1561
Practice Address - Fax:610-983-1569
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050659363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ18334Medicare UPIN