Provider Demographics
NPI:1912962465
Name:PERKOWSKI, THOMAS ANDREW (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANDREW
Last Name:PERKOWSKI
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 1:658 BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2027
Mailing Address - Country:US
Mailing Address - Phone:330-343-3213
Mailing Address - Fax:
Practice Address - Street 1:658 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2027
Practice Address - Country:US
Practice Address - Phone:330-343-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.007172207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2356052Medicaid
OH380618OtherANTHEM
OH41-218643600OtherBWC
OHPE4097363Medicare ID - Type Unspecified
OH41-218643600OtherBWC