Provider Demographics
NPI:1124212246
Name:THOMAS V MAROLDO, MD
Entity type:Organization
Organization Name:THOMAS V MAROLDO, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:MAROLDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-525-2220
Mailing Address - Street 1:PO BOX 2300 MSC 10044
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210
Mailing Address - Country:US
Mailing Address - Phone:509-525-4878
Mailing Address - Fax:
Practice Address - Street 1:401 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2846
Practice Address - Country:US
Practice Address - Phone:509-525-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034132174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8804555OtherMEDICARE GROUP PIN
WA1114156Medicaid
WA1114156Medicaid
WAE83062Medicare UPIN