MEDICARE: DR. JUDENE M. THOME 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	35060824T	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	:	1861450256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDENE M. THOME MD

Provider Business Mailing Address
First Line	:	25 MERCHANT STREET
Second Line	:	SUITE 220
City	:	CINCINNATI
State	:	OH
Zip	:	45246-3740
Country	:	US
Telephone Number	:	513-533-6507
Fax Number	:	513-645-9767

Provider Business Practice Location Address
First Line	:	6551 CENTERVILLE BUSINESS PKWY STE 110
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-2696
Country	:	US
Telephone Number	:	937-291-6850
Fax Number	:	937-291-6896

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/23/2020

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Directions to “ DR. JUDENE M. THOME MD” Practice Location

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