Provider Demographics
NPI:1639250830
Name:MCKINLEY, THOMAS DEAN (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:DEAN
Last Name:MCKINLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1330 COSHOCTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1440
Mailing Address - Country:US
Mailing Address - Phone:740-397-8500
Mailing Address - Fax:740-397-8527
Practice Address - Street 1:1451 YAUGER RD
Practice Address - Street 2:STE 1F
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-8097
Practice Address - Country:US
Practice Address - Phone:740-397-8500
Practice Address - Fax:740-397-8527
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35069886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0351828Medicaid
OH0351828Medicaid
OH0803805Medicare PIN