Provider Demographics
NPI:1932237922
Name:JAVORSKY, THOMAS JOSEPH (DPM)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:JAVORSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:LOWELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44436-9411
Mailing Address - Country:US
Mailing Address - Phone:330-536-8602
Mailing Address - Fax:330-536-8602
Practice Address - Street 1:1400 S HUBBARD RD
Practice Address - Street 2:
Practice Address - City:LOWELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44436-9411
Practice Address - Country:US
Practice Address - Phone:330-536-8602
Practice Address - Fax:330-536-8602
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003102213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2090213Medicaid
OHU73202Medicare UPIN
OHJA0864482Medicare ID - Type Unspecified
OH2090213Medicaid