MEDICARE: DR. EASAW THOMAS M.D.

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	207L00000X	Anesthesiology Physician	35-04-4224-T	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4028062	OTHER	OH	MEDICARE INDIVIDUAL PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000286047	OTHER	OH	ANTHEM PROVIDER #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659338432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EASAW THOMAS M.D.

Provider Business Mailing Address
First Line	:	180 S STANFIELD RD
Second Line	:	SUITE B
City	:	TROY
State	:	OH
Zip	:	45373-0106
Country	:	US
Telephone Number	:	937-440-9758
Fax Number	:	937-440-8872

Provider Business Practice Location Address
First Line	:	180 S STANFIELD RD
Second Line	:	SUITE B
City	:	TROY
State	:	OH
Zip	:	45373-0106
Country	:	US
Telephone Number	:	937-440-9758
Fax Number	:	937-440-8872

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	09/29/2014

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