Provider Demographics
NPI:1720053655
Name:PRESTON, THOMAS A (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:PRESTON
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 1:3200 BURNET AVE
Mailing Address - Street 2:3RD FLOOR CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3019
Mailing Address - Country:US
Mailing Address - Phone:513-585-5512
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-475-8263
Practice Address - Fax:513-475-7327
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-8719-P207RC0200X
IN01062225A207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0064901Medicaid
OHE68466Medicare UPIN
OHH084180Medicare PIN
OHPR0771222Medicare ID - Type UnspecifiedMEDICARE
OH1126050-005OtherCIGNA
OH4880094OtherUNITED HEALTHCARE
OHCB7003Medicare ID - Type UnspecifiedRR MEDICARE
OH0775915Medicaid
OH81000299Medicare ID - Type UnspecifiedRR MEDICARE
OH0674462Medicaid
OH000000014473OtherANTHEM