Provider Demographics
NPI:1366774051
Name:TOMASIC, KELLY (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:TOMASIC
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3685 STUTZ DR
Mailing Address - Street 2:STE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9175
Mailing Address - Country:US
Mailing Address - Phone:330-729-9514
Mailing Address - Fax:330-729-9591
Practice Address - Street 1:1053 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1007
Practice Address - Country:US
Practice Address - Phone:330-480-3605
Practice Address - Fax:330-480-2948
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.094320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3098482Medicaid
OH3098482Medicaid