Provider Demographics
NPI:1548432982
Name:DR THOMAS M POKABLA
Entity Type:Organization
Organization Name:DR THOMAS M POKABLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:POKABLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-856-1700
Mailing Address - Street 1:248 NILES CORTLAND RD NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1938
Mailing Address - Country:US
Mailing Address - Phone:330-856-1700
Mailing Address - Fax:
Practice Address - Street 1:248 NILES CORTLAND RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1938
Practice Address - Country:US
Practice Address - Phone:330-856-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001489332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0150483Medicaid
335440OtherHIGHMARK
OH0150483Medicaid
OH0649520001Medicare NSC
OHT80564Medicare UPIN