Provider Demographics
NPI:1821259987
Name:THOMA, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:THOMA
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:L-3401
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-3401
Mailing Address - Country:US
Mailing Address - Phone:740-615-1324
Mailing Address - Fax:740-615-1344
Practice Address - Street 1:551 W CENTRAL AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1493
Practice Address - Country:US
Practice Address - Phone:740-615-0300
Practice Address - Fax:740-615-0301
Is Sole Proprietor?:No
Enumeration Date:2008-06-21
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.091505208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2962049Medicaid
TH4267561Medicare PIN