Provider Demographics
NPI:1598749814
Name:SCHALCOSKY, THOMAS V (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:V
Last Name:SCHALCOSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 WARRENSVILLE CENTER RD BLDG 5
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7024
Mailing Address - Country:US
Mailing Address - Phone:216-491-7888
Mailing Address - Fax:216-491-7887
Practice Address - Street 1:4180 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-7024
Practice Address - Country:US
Practice Address - Phone:216-491-7888
Practice Address - Fax:216-491-7887
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102049850207Q00000X
OH34010077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005625718Medicaid
080188665OtherMEDICARE RAILROAD PROVIDER NUMBER
434853OtherANTHEM
VA015103C58Medicare PIN
080188665OtherMEDICARE RAILROAD PROVIDER NUMBER