Provider Demographics
NPI:1457390130
Name:VARA, THOMAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:VARA
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 1:6075 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-5131
Mailing Address - Country:US
Mailing Address - Phone:614-864-6363
Mailing Address - Fax:614-864-2248
Practice Address - Street 1:6075 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-5131
Practice Address - Country:US
Practice Address - Phone:614-864-6363
Practice Address - Fax:614-864-2248
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048045208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0632168Medicaid
OH1700554OtherUHC PROVIDER NUMBER
OH4264627OtherAETNA PROVIDER NUMBER
OH000000007677OtherBC/BS PROVIDER NUMBER
OH000000007677OtherBC/BS PROVIDER NUMBER
OH4264627OtherAETNA PROVIDER NUMBER
OH0632168Medicaid