Provider Demographics
NPI:1073504908
Name:MAK, THOMAS ALDEN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALDEN
Last Name:MAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1299 OLENTANGY RIVER RD
Mailing Address - Street 2:STE 103
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3135
Mailing Address - Country:US
Mailing Address - Phone:614-566-4278
Mailing Address - Fax:614-566-5424
Practice Address - Street 1:1299 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3135
Practice Address - Country:US
Practice Address - Phone:614-566-4710
Practice Address - Fax:614-566-6846
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH350636332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0226482Medicaid
OHMA0872523Medicare PIN
OHG82608Medicare UPIN