Provider Demographics
NPI:1154318467
Name:BARTSOKAS, TOM WIRTH (MD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:WIRTH
Last Name:BARTSOKAS
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:802 WAYNE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3300
Practice Address - Country:US
Practice Address - Phone:740-374-6030
Practice Address - Fax:740-374-6029
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.052565207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01604257OtherRAILROAD MEDICARE - MHCPI
WV3810028966Medicaid
OH0653985Medicaid
OH4272541OtherMEDICARE ID
A16797Medicare UPIN
WV3810028966Medicaid
OH0653985Medicaid