Basic Information
Provider Information
NPI: 1245453059
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TOMASZEWSKI
FirstName: MARA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2300 CHAMBER CENTER DRIVE
Address2:  
City: FT. MITCHELL
State: KY
PostalCode: 410171673
CountryCode: US
TelephoneNumber: 8599127211
FaxNumber: 8596558981
Practice Location
Address1: 1500 JAMES SIMPSON JR WAY
Address2:  
City: COVINGTON
State: KY
PostalCode: 41011
CountryCode: US
TelephoneNumber: 8599127211
FaxNumber: 8596558981
Other Information
ProviderEnumerationDate: 04/10/2007
LastUpdateDate: 08/02/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QG0300XTP820KYY Allopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
207QG0300X35.095658OHN Allopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine

ID Information
IDTypeStateIssuerDescription
308630605OH MEDICAID


Home