Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 35.78117 | OH |
N | 207V00000X | Obstetrician & Gynecologist | 35.78117 | OH |
N | 208D00000X | General Practice Physician | 35.078117 | OH |
NPI | 1285770883 |
---|---|
Provider Name | Joanne Poje Tomasulo |
First Address | Grove City, OH 43123-7925 |
Second Address | Grove City, OH 43123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 14/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2206937 | (05) | OH |
35.078117 | MEDICAL LICENSE NUMBER (01) | OH |
D24983 | (02) | OH |