Basic Information
| Provider Information | |||||||||
| NPI: | 1154318467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARTSOKAS | ||||||||
| FirstName: | TOM | ||||||||
| MiddleName: | WIRTH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 449 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457500449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403744500 | ||||||||
| FaxNumber: | 7403745887 | ||||||||
| Practice Location | |||||||||
| Address1: | 802 WAYNE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457503300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403746030 | ||||||||
| FaxNumber: | 7403746029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 03/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 35.052565 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01604257 | 01 | OH | RAILROAD MEDICARE - MHCPI | OTHER | 3810028966 | 05 | WV | MEDICAID | 0653985 | 05 | OH | MEDICAID | 4272541 | 01 | OH | MEDICARE ID | OTHER |