Provider Demographics
NPI:1992747893
Name:DEBERARDINIS, THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:DEBERARDINIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MERIDIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3202
Mailing Address - Country:US
Mailing Address - Phone:610-378-5428
Mailing Address - Fax:610-378-5470
Practice Address - Street 1:2 MERIDIAN BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3202
Practice Address - Country:US
Practice Address - Phone:610-378-5428
Practice Address - Fax:610-378-5470
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029943E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA065088TEXMedicare ID - Type Unspecified
B34715Medicare UPIN
PAB34715Medicare UPIN