Basic Information
| Provider Information | |||||||||
| NPI: | 1184653396 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIEHOWICZ | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 840 | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458020840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8775747116 | ||||||||
| FaxNumber: | 4192232726 | ||||||||
| Practice Location | |||||||||
| Address1: | 2520 VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | POINT PLEASANT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255502031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046754340 | ||||||||
| FaxNumber: | 3046755893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 34002974 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 1850 | WV | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0123563000 | 05 | WV | MEDICAID | 0549026 | 05 | OH | MEDICAID |