Healthcare Provider Details

I. General information

NPI: 1295029387
Provider Name (Legal Business Name): TOMMY JOHN PETROS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 01/25/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MCCONNELL DR
COLUMBUS OH
43214-3463
US

IV. Provider business mailing address

800 MCCONNELL DR
COLUMBUS OH
43214-3463
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-5019
  • Fax: 614-566-1901
Mailing address:
  • Phone: 614-566-5019
  • Fax: 614-566-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number35.132455
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: