Provider Demographics
NPI:1861450256
Name:THOME, JUDENE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDENE
Middle Name:M
Last Name:THOME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:25 MERCHANT STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3740
Mailing Address - Country:US
Mailing Address - Phone:513-533-6507
Mailing Address - Fax:513-645-9767
Practice Address - Street 1:6551 CENTERVILLE BUSINESS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-2696
Practice Address - Country:US
Practice Address - Phone:937-291-6850
Practice Address - Fax:937-291-6896
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35060824T208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0834191Medicaid
OHTH0802512Medicare PIN
110180078Medicare PIN
OH0802512Medicare PIN
OHG26336Medicare UPIN