Provider Demographics
NPI:1023005261
Name:OLSEN, THOMAS GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GEORGE
Last Name:OLSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7835 PARAGON RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4021
Mailing Address - Country:US
Mailing Address - Phone:937-434-2351
Mailing Address - Fax:937-434-1381
Practice Address - Street 1:7835 PARAGON RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4021
Practice Address - Country:US
Practice Address - Phone:937-434-2351
Practice Address - Fax:937-434-1381
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350460580207N00000X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A80808Medicare UPIN
OHOL0544595Medicare PIN