Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 34004827 | OH |
N | 207QA0401X | Family Doctor - Addiction Medicine | 34004827 | OH |
N | 207R00000X | Internist | 34004827 | OH |
N | 111NI0900X | Internist | 34004827 | OH |
N | 207RA0401X | Internist - Addiction Medicine | 34004827 | OH |
NPI | 1770559783 |
---|---|
Provider Name | Thomas P. D'onofrio |
First Address | North Olmsted, OH 44070-0789 |
Second Address | Columbus, OH 43213-2425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 13/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E97144 | (02) | OH |