Provider Demographics
NPI:1164568119
Name:LOLAN, THOMAS C (MA, FAAA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:C
Last Name:LOLAN
Suffix:
Gender:M
Credentials:MA, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 EAST STROOP
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429
Mailing Address - Country:US
Mailing Address - Phone:937-299-2004
Mailing Address - Fax:937-299-0918
Practice Address - Street 1:1305 E STROOP RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4925
Practice Address - Country:US
Practice Address - Phone:937-299-2004
Practice Address - Fax:937-299-0918
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00106237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0891227Medicaid
OH000000314750Medicare UPIN
OH61101Medicare UPIN
OH62308Medicare UPIN
OH0891227Medicaid
OHLO0523832Medicare ID - Type Unspecified
OH7401380Medicare UPIN