Provider Demographics
NPI:1851508097
Name:TOMBLIN, CRISTAL DENISE (MD)
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:DENISE
Last Name:TOMBLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 KOLBE RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1611
Mailing Address - Country:US
Mailing Address - Phone:440-960-3985
Mailing Address - Fax:440-960-4277
Practice Address - Street 1:3700 KOLBE RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1611
Practice Address - Country:US
Practice Address - Phone:440-960-3985
Practice Address - Fax:440-960-4277
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.086918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2499907Medicaid