Provider Demographics
NPI:1518158773
Name:BAKONDY, THOMAS JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:BAKONDY
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 1:101 WATERSIDE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-9661
Mailing Address - Country:US
Mailing Address - Phone:330-206-2736
Mailing Address - Fax:
Practice Address - Street 1:101 WATERSIDE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-9661
Practice Address - Country:US
Practice Address - Phone:330-206-2736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS212962085R0202X
CAA1021152085R0202X
TXM85172085R0202X
NC2008-019502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203653501Medicaid
TX1518158773OtherBLUE CROSS BLUE SHIELD
TX1518158773OtherBLUE CROSS BLUE SHIELD
MS302I304601Medicare PIN
TX8L15273Medicare PIN