Healthcare Provider Details

I. General information

NPI: 1104820059
Provider Name (Legal Business Name): THOMAS DONALD MACABOBBY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8423 MARKET ST STE 101
BOARDMAN OH
44512-6778
US

IV. Provider business mailing address

8423 MARKET ST STE 101
BOARDMAN OH
44512-6778
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-8700
  • Fax: 330-729-8701
Mailing address:
  • Phone: 330-729-8700
  • Fax: 330-729-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-085267
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: