Healthcare Provider Details

I. General information

NPI: 1790890879
Provider Name (Legal Business Name): THOMAS WALTER VONDOHLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E MEADOW LN
CALDWELL WV
24925-7139
US

IV. Provider business mailing address

157 SKYLAR DR
LEWISBURG WV
24901-9359
US

V. Phone/Fax

Practice location:
  • Phone: 304-647-2030
  • Fax: 304-647-2033
Mailing address:
  • Phone: 304-647-2030
  • Fax: 304-647-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number13305
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: