Healthcare Provider Details

I. General information

NPI: 1366482564
Provider Name (Legal Business Name): THOMAS JOHN PARKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 OLENTANGY RIVER ROAD SUITE 3070
COLUMBUS OH
43214
US

IV. Provider business mailing address

3555 OLENTANGY RIVER ROAD SUITE 3070
COLUMBUS OH
43214
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-2166
  • Fax: 614-533-0029
Mailing address:
  • Phone: 614-566-2166
  • Fax: 614-533-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.058822
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35058822
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: