Basic Information
| Provider Information | |||||||||
| NPI: | 1841700762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOMICH | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | STEPHEN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4217 NORTHERN PIKE | ||||||||
| Address2: | |||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151462713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123729100 | ||||||||
| FaxNumber: | 4123726952 | ||||||||
| Practice Location | |||||||||
| Address1: | 4217 NORTHERN PIKE | ||||||||
| Address2: | |||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151462713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123729100 | ||||||||
| FaxNumber: | 4123726952 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2017 | ||||||||
| LastUpdateDate: | 10/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA059541 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.