Healthcare Provider Details

I. General information

NPI: 1003893470
Provider Name (Legal Business Name): THOMAS OSTRONIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DILORENZO TRICARE HEALTH CLINIC 5801 ARMY PENTAGON, CORRIDOR 8
WASHINGTON DC
20310-5801
US

IV. Provider business mailing address

7111 WOODMONT AVE APT 618
CHEVY CHASE MD
20815-6200
US

V. Phone/Fax

Practice location:
  • Phone: 703-692-0965
  • Fax:
Mailing address:
  • Phone: 301-657-3497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD047309L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: