Provider Demographics
NPI:1457628158
Name:TOMSHO, GINA MARIE (DPM)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:TOMSHO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 1ST ST NW
Mailing Address - Street 2:STE 2
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-2555
Mailing Address - Country:US
Mailing Address - Phone:330-753-7772
Mailing Address - Fax:330-753-2610
Practice Address - Street 1:200 1ST ST NW
Practice Address - Street 2:STE 2
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-2555
Practice Address - Country:US
Practice Address - Phone:330-753-7772
Practice Address - Fax:330-753-2610
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003668213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0096692Medicaid
OH0096692Medicaid
OHP01318786Medicare PIN