Provider Demographics
NPI:1043320070
Name:HOUSTON, THOMAS P (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:HOUSTON
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 1:1299 OLENTANGY RIVER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3140
Mailing Address - Country:US
Mailing Address - Phone:614-566-4278
Mailing Address - Fax:614-566-5424
Practice Address - Street 1:3773 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3425
Practice Address - Country:US
Practice Address - Phone:614-566-5356
Practice Address - Fax:614-566-3835
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0468800Medicaid
OHHO4179361Medicare PIN