Provider Demographics
NPI:1578535811
Name:HULL, THOMAS PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PATRICK
Last Name:HULL
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 1:650 GRAHAM RD
Mailing Address - Street 2:STE 103
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1052
Mailing Address - Country:US
Mailing Address - Phone:330-434-1185
Mailing Address - Fax:330-434-8533
Practice Address - Street 1:650 GRAHAM RD
Practice Address - Street 2:STE 103
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1052
Practice Address - Country:US
Practice Address - Phone:330-434-1185
Practice Address - Fax:330-434-8533
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069159207WX0107X
OH35069159H207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2116490Medicaid
OH2116490Medicaid
4144542Medicare ID - Type Unspecified75 ARCH STREET, 302
4144544Medicare ID - Type Unspecified9480 ROSEMONT DR
4144545Medicare ID - Type Unspecified2013 STATE ROUTE 59
G92796Medicare UPIN
4144547Medicare ID - Type Unspecified3591 RESERVE COMMONS DR
0874212Medicare ID - Type Unspecified
4144543Medicare ID - Type Unspecified150 SPRINGSIDE DR, C330