Provider Demographics
NPI:1538151832
Name:DICKSON, THOMAS B (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:DICKSON
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 1:250 CETRONIA RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9168
Mailing Address - Country:US
Mailing Address - Phone:610-973-6200
Mailing Address - Fax:610-973-6546
Practice Address - Street 1:250 CETRONIA ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9168
Practice Address - Country:US
Practice Address - Phone:610-973-6200
Practice Address - Fax:610-973-6546
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009404E207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA019360OtherKEYSTONE CENTRAL
PAP975753OtherOXFORD
PA18864OtherGEISINGER
PA0040119000OtherKEYSTONE EAST
PA019360OtherBLUE SHIELD
PA01189301OtherBLUE CROSS
PA4270763OtherAETNA
PA0006819880002Medicaid
PA200009504OtherRAILROAD MEDICARE
PA231857130OtherDEVON
PA019360OtherAMERIHEALTH ADMIN
PA821239OtherFIRST PRIORITY HEALTH
PA0040119000OtherKEYSTONE EAST
PA0006819880002Medicaid