Provider Demographics
NPI:1861455271
Name:AQUISTO, THOMAS M (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:AQUISTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2233 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3831
Mailing Address - Country:US
Mailing Address - Phone:970-765-0831
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:800 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4212
Practice Address - Country:US
Practice Address - Phone:970-249-2211
Practice Address - Fax:847-570-2942
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361110382085R0202X, 2085R0204X
WAMD616057532085R0202X
AZ636692085R0204X
CODR.00632342085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000216791Medicaid
IL036111038Medicaid