Healthcare Provider Details

I. General information

NPI: 1609570282
Provider Name (Legal Business Name): MARYO A TOMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 OLD PLEASANT GROVE RD
MT JULIET TN
37122-4493
US

IV. Provider business mailing address

222 22ND AVE N
NASHVILLE TN
37203-1802
US

V. Phone/Fax

Practice location:
  • Phone: 629-255-2074
  • Fax: 629-255-4149
Mailing address:
  • Phone: 629-255-3486
  • Fax: 629-255-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number77523
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: