Provider Demographics
NPI:1790816148
Name:DILWORTH, THOMAS JOSEPH
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:DILWORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1303
Mailing Address - Country:US
Mailing Address - Phone:937-602-1929
Mailing Address - Fax:
Practice Address - Street 1:3 SECOND STREET
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1303
Practice Address - Country:US
Practice Address - Phone:937-602-1929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2143460Medicaid