Provider Demographics
NPI:1578959052
Name:TOMSIC, MARTHA PAIGE (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:PAIGE
Last Name:TOMSIC
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:TOMSIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:118 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3107
Mailing Address - Country:US
Mailing Address - Phone:662-534-0898
Mailing Address - Fax:662-534-8905
Practice Address - Street 1:118 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3107
Practice Address - Country:US
Practice Address - Phone:662-534-0898
Practice Address - Fax:662-534-8905
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26821208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS100243651Medicaid