Basic Information
Provider Information | |||||||||
NPI: | 1003844366 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | O'BRIEN | ||||||||
FirstName: | THOMAS | ||||||||
MiddleName: | M. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 237 WILLIAM HOWARD TAFT RD | ||||||||
Address2: | 2ND FLOOR, CBO 2-3 | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452192610 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5132061180 | ||||||||
FaxNumber: | 5132061182 | ||||||||
Practice Location | |||||||||
Address1: | 7335 YANKEE RD | ||||||||
Address2: | SU. 201 | ||||||||
City: | LIBERTY TOWNSHIP | ||||||||
State: | OH | ||||||||
PostalCode: | 450440006 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5132061460 | ||||||||
FaxNumber: | 5132061479 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/28/2006 | ||||||||
LastUpdateDate: | 06/21/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35082223O | OH | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RA0001X | 35082223 | OH | Y |   |   |   |   |
ID Information
ID | Type | State | Issuer | Description | 2833643 | 05 | OH |   | MEDICAID |