Provider Demographics
NPI:1407854144
Name:WANKO, THOMAS E (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:WANKO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:104 N MURRAY HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1524
Practice Address - Country:US
Practice Address - Phone:614-878-6413
Practice Address - Fax:614-878-1159
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002187207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0309320Medicaid
OHE00617Medicare UPIN
OHWA0424257Medicare PIN