Provider Demographics
NPI:1609889401
Name:THALER, DEBORAH H (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:H
Last Name:THALER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:HOPE
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:12780 ROACHTON RD
Mailing Address - Street 2:#1
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551
Mailing Address - Country:US
Mailing Address - Phone:419-872-0777
Mailing Address - Fax:419-872-2369
Practice Address - Street 1:12780 ROACHTON RD
Practice Address - Street 2:#1
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551
Practice Address - Country:US
Practice Address - Phone:419-872-0777
Practice Address - Fax:419-872-2369
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3400796513207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3400796513OtherOHIO STATE MEDICAL BOARD
BU4136131Medicare PIN
OH3400796513OtherOHIO STATE MEDICAL BOARD
BU4136131Medicare PIN
OHI09050Medicare UPIN