Provider Demographics
NPI:1740273531
Name:ZEGARSKI, THOMAS JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:ZEGARSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:200 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2400
Mailing Address - Country:US
Mailing Address - Phone:419-300-1129
Mailing Address - Fax:419-394-9575
Practice Address - Street 1:1010 HAGER ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2421
Practice Address - Country:US
Practice Address - Phone:419-394-9579
Practice Address - Fax:419-394-9580
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35065349208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105065OtherGROUP MEDICAID6/1/17
OH2091883Medicaid
OH1184652539OtherGROUP NPI AS OF 6/1/2017
OH34-1689161OtherJTDM FAMILY PRACTICE LLC AS OF 6/1/2017