Provider Demographics
NPI:1194811224
Name:THOMAS, GEORGE (DO)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
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 714328
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-4328
Mailing Address - Country:US
Mailing Address - Phone:216-261-7970
Mailing Address - Fax:216-261-6191
Practice Address - Street 1:26151 EUCLID AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3300
Practice Address - Country:US
Practice Address - Phone:216-261-7970
Practice Address - Fax:216-261-6191
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002140207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0215305Medicaid
OHH162890Medicare PIN
OHD89527Medicare UPIN