Provider Demographics
NPI:1679570220
Name:TAXMAN, THOMAS LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LOUIS
Last Name:TAXMAN
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 1:29001 CEDAR RD STE 500
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6501
Mailing Address - Country:US
Mailing Address - Phone:440-442-0500
Mailing Address - Fax:440-442-0501
Practice Address - Street 1:29001 CEDAR RD STE 500
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-6501
Practice Address - Country:US
Practice Address - Phone:440-442-0500
Practice Address - Fax:440-442-0501
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050627T174400000X
OH35050627174400000X, 2080P0206X
OH35.050627207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0638546Medicaid
OHA17206Medicare UPIN
OH0609274Medicare PIN
OHA17006Medicare UPIN