Provider Demographics
NPI:1013534809
Name:PISANO, THOMAS JOHN (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:PISANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:3 W GATES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-662-3606
Mailing Address - Fax:215-349-5579
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:2 RAVDIN
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-662-3606
Practice Address - Fax:215-349-5579
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2025-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA127213002084N0400X
PAMD4884932084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology