Provider Demographics
NPI:1336102888
Name:ARCHER, THOMAS PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PATRICK
Last Name:ARCHER
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 1:1322 BERKELEY CT
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7809
Mailing Address - Country:US
Mailing Address - Phone:614-847-1898
Mailing Address - Fax:
Practice Address - Street 1:477 COOPER RD STE 200
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8054
Practice Address - Country:US
Practice Address - Phone:614-627-2000
Practice Address - Fax:614-221-8869
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065935A207RA0001X, 207RA0002X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH060054384OtherRAILROAD MEDICARE
OH2501822OtherUNITED HEALTHCARE OF OHIO
289254OtherBLACK LUNG
OH0956032Medicaid
060054384OtherRAILROAD MEDICARE
OH13716OtherNATIONWIDE HEALTH PLANS
OH366278OtherMEDIGAP BCBS
4559220OtherCIGNA
OH00000000198947OtherANTHEM BCBS
OH45592200005OtherCIGNA
AR0760045Medicare ID - Type Unspecified
OH00000000198947OtherANTHEM BCBS
OH366278OtherMEDIGAP BCBS
OH13716OtherNATIONWIDE HEALTH PLANS
OH060054384OtherRAILROAD MEDICARE
AR0760044Medicare ID - Type Unspecified