Individual
DR. EASAW THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
180 S STANFIELD RD, SUITE B, TROY, OH 45373-0106
(937) 440-9758
(937) 440-8872
Mailing address
180 S STANFIELD RD, SUITE B, TROY, OH 45373-0106
(937) 440-9758
(937) 440-8872
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
35-04-4224-T
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000286047
ANTHEM PROVIDER #
OH
05
—
2398696
—
OH
01
—
4028062
MEDICARE INDIVIDUAL PTAN
OH
Enumeration date
04/27/2006
Last updated
09/29/2014
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