Healthcare Provider Details

I. General information

NPI: 1639571938
Provider Name (Legal Business Name): THOMAS LUMSDEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 ENGLE RD STE I
MIDDLEBURG HEIGHTS OH
44130-7930
US

IV. Provider business mailing address

30701 LORAIN RD STE A
NORTH OLMSTED OH
44070-6325
US

V. Phone/Fax

Practice location:
  • Phone: 440-517-4700
  • Fax: 440-517-4700
Mailing address:
  • Phone: 440-517-4700
  • Fax: 440-517-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number50.004110RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number50.004110RX
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50004110
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: