Provider Demographics
NPI:1376544916
Name:CARRIGAN, THOMAS WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WARREN
Last Name:CARRIGAN
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 1:3130 N COUNTY RD 25A
Mailing Address - Street 2:SUITE 109
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1337
Mailing Address - Country:US
Mailing Address - Phone:937-440-9292
Mailing Address - Fax:937-440-4227
Practice Address - Street 1:3130 N COUNTY RD 25A
Practice Address - Street 2:SUITE 109
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:937-440-9292
Practice Address - Fax:937-440-4227
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053465207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0736681Medicaid
OHCA0632901Medicare ID - Type Unspecified
OH0736681Medicaid