Healthcare Provider Details

I. General information

NPI: 1194793778
Provider Name (Legal Business Name): MARK J. THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10496 MONTGOMERY RD STE 203
CINCINNATI OH
45242
US

IV. Provider business mailing address

PO BOX 636209
CINCINNATI OH
45263-6209
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-2348
  • Fax: 513-865-2354
Mailing address:
  • Phone: 513-865-2348
  • Fax: 513-865-2354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number35-083286
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35083286
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: