Provider Demographics
NPI:1003220963
Name:TRAINER, THOMAS ALFONSO
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALFONSO
Last Name:TRAINER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3066 KENT RD
Mailing Address - Street 2:209B
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4419
Mailing Address - Country:US
Mailing Address - Phone:330-813-1042
Mailing Address - Fax:
Practice Address - Street 1:3066 KENT RD
Practice Address - Street 2:#209B
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4419
Practice Address - Country:US
Practice Address - Phone:330-813-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0056437Medicaid