Provider Demographics
NPI:1396834131
Name:PHELPS, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:PHELPS
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 1:8254 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2593
Mailing Address - Country:US
Mailing Address - Phone:440-727-0100
Mailing Address - Fax:440-729-0080
Practice Address - Street 1:8254 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2593
Practice Address - Country:US
Practice Address - Phone:440-727-0100
Practice Address - Fax:440-729-0080
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056917P208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E76401Medicare UPIN