Provider Demographics
NPI:1831138346
Name:THOMAS, MELVIN W (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:W
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MELVIN
Other - Middle Name:WILSON
Other - Last Name:THOMAS
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4278 INDIANOLA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2806
Mailing Address - Country:US
Mailing Address - Phone:614-262-0477
Mailing Address - Fax:614-268-1677
Practice Address - Street 1:4278 INDIANOLA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2806
Practice Address - Country:US
Practice Address - Phone:614-262-0477
Practice Address - Fax:614-268-1677
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.049249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0962623Medicaid
C75300Medicare UPIN
OHTH4016211Medicare PIN
OH000000191961OtherANTHEM BC/BS
OHTH4016211Medicare ID - Type Unspecified