Provider Demographics
NPI:1245266402
Name:MADRILEJOS, TOMAS ALMONTE (MD)
Entity type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:ALMONTE
Last Name:MADRILEJOS
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 1:930 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2130
Mailing Address - Country:US
Mailing Address - Phone:330-723-3220
Mailing Address - Fax:
Practice Address - Street 1:930 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2130
Practice Address - Country:US
Practice Address - Phone:330-723-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0389404Medicaid
OH0389404Medicaid