Provider Demographics
NPI:1326175027
Name:THOMAS GUSTAFERRO MD INC
Entity Type:Organization
Organization Name:THOMAS GUSTAFERRO MD INC
Other - Org Name:DRS. JUHANT AND GUSTAFERRO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GUSTAFERRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-498-9791
Mailing Address - Street 1:12000 MCCRACKEN RD
Mailing Address - Street 2:STE 101
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2964
Mailing Address - Country:US
Mailing Address - Phone:216-662-2200
Mailing Address - Fax:216-662-6282
Practice Address - Street 1:12000 MCCRACKEN RD
Practice Address - Street 2:STE 101
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2964
Practice Address - Country:US
Practice Address - Phone:216-662-2200
Practice Address - Fax:216-662-6282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9297732Medicare PIN