MEDICARE: THOMAS E. DARRAH D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34-00-3342-D	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114947454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS E. DARRAH D.O.

Provider Business Mailing Address
First Line	:	130 N DETROIT ST
Second Line	:
City	:	BELLEFONTAINE
State	:	OH
Zip	:	43311-1464
Country	:	US
Telephone Number	:	937-599-3085
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 N DETROIT ST
Second Line	:
City	:	BELLEFONTAINE
State	:	OH
Zip	:	43311-1464
Country	:	US
Telephone Number	:	937-599-3085
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	05/21/2008

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