Provider Demographics
NPI:1922038124
Name:DEPOLO, THOMAS J (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:DEPOLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-2633
Mailing Address - Country:US
Mailing Address - Phone:440-884-4100
Mailing Address - Fax:440-884-4742
Practice Address - Street 1:5625 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-2633
Practice Address - Country:US
Practice Address - Phone:440-884-4100
Practice Address - Fax:440-884-4742
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003030213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH480027507OtherRAILROAD MEDICARE
OH2049590Medicaid
OH480027507OtherRAILROAD MEDICARE
OHU70035Medicare UPIN
OH0846142Medicare PIN