Provider Demographics
NPI:1750373403
Name:REPKO, THOMAS A (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:REPKO
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 1:95 ARCH ST
Mailing Address - Street 2:STE. 120
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1437
Mailing Address - Country:US
Mailing Address - Phone:330-535-2521
Mailing Address - Fax:330-535-6845
Practice Address - Street 1:95 ARCH ST
Practice Address - Street 2:STE. 120
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1437
Practice Address - Country:US
Practice Address - Phone:330-535-2521
Practice Address - Fax:330-535-6845
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047918R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0658551Medicaid
OH0658551Medicaid