Provider Demographics
NPI:1790890879
Name:VONDOHLEN, THOMAS WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WALTER
Last Name:VONDOHLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:157 SKYLAR DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9359
Mailing Address - Country:US
Mailing Address - Phone:304-647-2030
Mailing Address - Fax:304-647-2033
Practice Address - Street 1:157 SKYLAR DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9359
Practice Address - Country:US
Practice Address - Phone:304-647-2030
Practice Address - Fax:304-647-2033
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV13305207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0073887000Medicaid
WVP00480835OtherRAILROAD MEDICARE
WV0073887000Medicaid
WV9365141Medicare PIN