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General NPI Number Information
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NPI Number | 1104123595
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Entity Type | Organization
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Legal Business Name | TOM VIOLAND, D.O. MEDICAL CLINIC
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Dates
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Enumeration Date | 02/21/2011
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Last Update Date | 02/21/2011
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Provider Practice Location Address
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Address Line | 4088 HOLIDAY ST NW
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City | CANTON
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State | OH
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Zip | 44718-2513
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Country | US
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Telephone | 330-491-9797
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Fax | 330-491-9820
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Provider Business Mailing Address
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Address Line | 4088 HOLIDAY ST NW
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City | CANTON
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State | OH
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Zip | 44718-2513
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Country | US
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Telephone | 330-491-9797
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Fax | 330-491-9820
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS E VIOLAND
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Credential | D.O.
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Telephone | 330-491-9797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 34.001130
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 34.001130
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License Number State | OH
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