Thomas Nicholas Detesco, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

35100173D Issued in OH

Practice address

7341 Eisenhower Dr
Boardman, OH 44512-5900

Phone

(330) 726-1138

Fax

(330) 726-6128

NPI assigned

Jun 13, 2005

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ohio North East Health Systems, Inc.

  • Community Health Clinic/Center
  • Youngstown, OH
  • NPI 1700917267

  Internal Medicine

  Medicare reassignment NPD
• First Medical Associates Inc

  • Internal Medicine Physician
  • Boardman, OH
  • NPI 1609877687
  Authorized official Same address or phone
• Ohio North East Health Systems Inc

  dba Northside Dental Center

  • Federally Qualified Health Center (FQHC)
  • Youngstown, OH
  • NPI 1699236059
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1013911403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7341 EISENHOWER DR",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125900",
            "telephone_number": "330-726-1138",
            "fax_number": "330-726-6128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7341 EISENHOWER DR",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125900",
            "telephone_number": "330-726-1138",
            "fax_number": "330-726-6128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETESCO",
        "first_name": "THOMAS",
        "middle_name": "NICHOLAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-13",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35100173D",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis P Orr II DO LLC
• Dental Express Boardman, Ted a Schuster DDS LLC
• Desai G. Krishna-Rao (Boardman Allergy Associates)
• David Paul Desantis, D.C.
• Dianne Marie Despetorich, CPNP-PC
• Gregory Scott Dew, D.C., PA-C
• Dialysis Access Center, LLC
• Casey Dickey, PA-C
• Joseph A Didomenico, D.C.
• Lawrence Didomenico, DPM

• Internal Medicine Physician in Boardman, OH
• Providers in Boardman, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.