MEDICARE: DR. MARK J. THOMAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204F00000X	Transplant Surgery Physician	35-083286	OH
2	208600000X	Surgery Physician	35083286	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194793778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK J. THOMAS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 636209
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-6209
Country	:	US
Telephone Number	:	513-865-2348
Fax Number	:	513-865-2354

Provider Business Practice Location Address
First Line	:	10496 MONTGOMERY RD
Second Line	:	STE 203
City	:	CINCINNATI
State	:	OH
Zip	:	45242
Country	:	US
Telephone Number	:	513-865-2348
Fax Number	:	513-865-2354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	04/02/2009

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