Basic Information
| Provider Information | |||||||||
| NPI: | 1699762229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POMMERING | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 CHILDRENS DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432052664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143556000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 584 COUNTY LINE RD W | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430827295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143556000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 02/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34005529 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 34005529 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 2080S0010X | 34005529 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0111033 | 05 | OH | MEDICAID |