Individual
THOMAS D CERVONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
789 EASTERN BYP, SUITE 5, RICHMOND, KY 40475-2415
(859) 624-4110
(859) 624-1968
Mailing address
789 EASTERN BYP, SUITE 5, RICHMOND, KY 40475-2415
(859) 624-4110
(859) 624-1968
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
34845
KY
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
34845
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000311405
ANTHEM BLUECROSS & BLUESH
KY
01
—
200312945
FEDERAL TAX ID
KY
01
—
5245840001
DMEPOS ADMINISTAR
KY
01
—
5623185
AETNA PROVIDER ID
—
05
—
64035546
—
KY
01
—
P00111547
TRAVELERS MEDICARE NUMBER
KY
Enumeration date
10/13/2006
Last updated
03/07/2023
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