Basic Information
| Provider Information | |||||||||
| NPI: | 1558351627 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZANDERS | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | BRUCE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O., FACP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 709 DELAWARE AVE | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845263890 | ||||||||
| FaxNumber: | 8668298936 | ||||||||
| Practice Location | |||||||||
| Address1: | 709 DELAWARE AVE | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845263890 | ||||||||
| FaxNumber: | 8668298936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 12/14/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C2-0007275 | DE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | OS016291 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | OS016291 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | OS016291 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 275503 | 01 | PA | MEDICARE | OTHER | 2862489 | 01 | PA | BLUE SHIELD | OTHER | 102802860 | 05 | PA | MEDICAID |