Provider Demographics
NPI:1104123595
Name:TOM VIOLAND, D.O. MEDICAL CLINIC
Entity type:Organization
Organization Name:TOM VIOLAND, D.O. MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:VIOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-491-9797
Mailing Address - Street 1:4088 HOLIDAY ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2513
Mailing Address - Country:US
Mailing Address - Phone:330-491-9797
Mailing Address - Fax:330-491-9820
Practice Address - Street 1:4088 HOLIDAY ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2513
Practice Address - Country:US
Practice Address - Phone:330-491-9797
Practice Address - Fax:330-491-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.001130207QS0010X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty