Healthcare Provider Details

I. General information

NPI: 1245453059
Provider Name (Legal Business Name): MARA TOMASZEWSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 N FAIRFIELD RD STE 100
BEAVERCREEK OH
45431-2783
US

IV. Provider business mailing address

2145 N FAIRFIELD RD STE 100
BEAVERCREEK OH
45431-2783
US

V. Phone/Fax

Practice location:
  • Phone: 937-558-3900
  • Fax:
Mailing address:
  • Phone: 937-558-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number35.095658
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number51747
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: