Provider Demographics
NPI:1194793778
Name:THOMAS, MARK J (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636209
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6209
Mailing Address - Country:US
Mailing Address - Phone:513-865-2348
Mailing Address - Fax:513-865-2354
Practice Address - Street 1:10496 MONTGOMERY RD
Practice Address - Street 2:STE 203
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-865-2348
Practice Address - Fax:513-865-2354
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-083286204F00000X
OH35083286208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2435038Medicaid
OH2435038Medicaid
OH4118263Medicare PIN
OH4118261Medicare PIN