Provider Demographics
NPI:1386644938
Name:SMALLWOOD, THOMAS EDWARD (MD,CMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:SMALLWOOD
Suffix:
Gender:M
Credentials:MD,CMD
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Mailing Address - Street 1:5210 RENWYCK DR
Mailing Address - Street 2:STE C
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-5968
Mailing Address - Country:US
Mailing Address - Phone:419-385-5751
Mailing Address - Fax:419-385-7162
Practice Address - Street 1:5210 RENWYCK DRIVE
Practice Address - Street 2:STE C
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-0905
Practice Address - Country:US
Practice Address - Phone:419-385-5751
Practice Address - Fax:419-385-7162
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35067079S207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0976878Medicaid
OH0976878Medicaid
OHH390870Medicare PIN