MEDICARE: THOMAS JOSEPH ZEGARSKI MD

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	208000000X	Pediatrics Physician	35065349	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1184652539	OTHER	OH	GROUP NPI AS OF 6/1/2017
4	34-1689161	OTHER	OH	JTDM FAMILY PRACTICE LLC AS OF 6/1/2017

General Provider Information

NPI Number	:	1740273531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS JOSEPH ZEGARSKI MD

Provider Business Mailing Address
First Line	:	200 SAINT CLAIR AVE
Second Line	:
City	:	SAINT MARYS
State	:	OH
Zip	:	45885-2400
Country	:	US
Telephone Number	:	419-300-1129
Fax Number	:	419-394-9575

Provider Business Practice Location Address
First Line	:	1010 HAGER ST
Second Line	:
City	:	SAINT MARYS
State	:	OH
Zip	:	45885-2421
Country	:	US
Telephone Number	:	419-394-9579
Fax Number	:	419-394-9580

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	08/10/2020

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