Provider Demographics
NPI:1730147067
Name:CIOTOLA, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:CIOTOLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:141 N VINE ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201
Practice Address - Country:US
Practice Address - Phone:570-454-2467
Practice Address - Fax:570-455-2070
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD019396E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001122527-0003Medicaid
PA0011225270001Medicaid
P00094194OtherRAILROAD MEDICARE
080573OtherFIRST PRIORITY HEALTH
50005162OtherCAPITAL BLUE CROSS
PA036831D3BMedicare PIN