Healthcare Provider Details

I. General information

NPI: 1083650519
Provider Name (Legal Business Name): THOMAS J PEDRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 OLENTANGY RIVER RD
COLUMBUS OH
43214-3937
US

IV. Provider business mailing address

PO BOX 182039 DEPT 086
COLUMBUS OH
43218-2039
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-5000
  • Fax: 614-566-6958
Mailing address:
  • Phone: 614-430-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35051913
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: