Provider Demographics
NPI:1902056013
Name:THOMAS J CRAPARO
Entity Type:Organization
Organization Name:THOMAS J CRAPARO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-282-1404
Mailing Address - Street 1:10 DUNDAFF ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1869
Mailing Address - Country:US
Mailing Address - Phone:570-282-1404
Mailing Address - Fax:570-282-1904
Practice Address - Street 1:10 DUNDAFF ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1869
Practice Address - Country:US
Practice Address - Phone:570-282-1404
Practice Address - Fax:570-282-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021027E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006014030001Medicaid
PA0006014030001Medicaid