Provider Demographics
NPI:1285770883
Name:TOMASULO, JOANNE POJE (MD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:POJE
Last Name:TOMASULO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:POJE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5455 LILAC AVE
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-7925
Mailing Address - Country:US
Mailing Address - Phone:614-302-8023
Mailing Address - Fax:614-302-8023
Practice Address - Street 1:5455 LILAC AVE
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123
Practice Address - Country:US
Practice Address - Phone:614-302-8023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.78117207V00000X, 207QA0401X
OH350781172083A0300X
OH35.078117208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2206937Medicaid
OH35.078117OtherMEDICAL LICENSE NUMBER
OH35.078117OtherMEDICAL LICENSE NUMBER