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1154318194

NPI Code Detail

MEDICARE: TOM MITROS MD

MEDICARE: TOM MITROS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	CI006035	DE
2	207L00000X	Anesthesiology Physician	C1-0006035	DE
3	207L00000X	Anesthesiology Physician	25MA06549800	NJ
4	207LP2900X	Pain Medicine (Anesthesiology) Physician	MD025772E	PA
5	207L00000X	Anesthesiology Physician	MD025772E	PA

General Provider Information

NPI Number	:	1154318194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOM MITROS MD

Provider Business Mailing Address
First Line	:	68 S SERVICE RD
Second Line	:	SUITE 350
City	:	MELVILLE
State	:	NY
Zip	:	11747-2354
Country	:	US
Telephone Number	:	516-945-3347
Fax Number	:	516-945-3131

Provider Business Practice Location Address
First Line	:	23 N WALNUT ST
Second Line	:
City	:	BOYERTOWN
State	:	PA
Zip	:	19512-1467
Country	:	US
Telephone Number	:	610-367-8844
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	12/05/2023

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Directions to “ TOM MITROS MD” Practice Location

Language	Start Address	Practice Location

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