Provider Demographics
NPI:1013970581
Name:FANNING, THOMAS S (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:FANNING
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 1:2786 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9367
Mailing Address - Country:US
Mailing Address - Phone:740-657-3731
Mailing Address - Fax:
Practice Address - Street 1:745 W STATE ST
Practice Address - Street 2:SUITE 750
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1515
Practice Address - Country:US
Practice Address - Phone:614-224-2281
Practice Address - Fax:614-221-8869
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3506761F207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
28478453001OtherMEDICAL MUTUAL OF OHIO
OH2207463Medicaid
060060628OtherRAILROAD MEDICARE
OH2847815300OtherBUREAU OF WORKERS COM
2502117OtherUNITED HEALTHCARE
00000000203679OtherANTHEM BCBS
OH060060628OtherRAILROAD MEDICARE
61238OtherNATIONWIDE
00000000203679OtherANTHEM BCBS
F98353Medicare UPIN
OH2847815300OtherBUREAU OF WORKERS COM