Provider Demographics
NPI:1477159127
Name:THOMAS-BANDMAN, VICTORIA K
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:K
Last Name:THOMAS-BANDMAN
Suffix:
Gender:F
Credentials:
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 625
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-0625
Mailing Address - Country:US
Mailing Address - Phone:614-580-8288
Mailing Address - Fax:
Practice Address - Street 1:6604 QUAIL LK
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7001
Practice Address - Country:US
Practice Address - Phone:614-580-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0149319Medicaid