MEDICARE: MARY BETH TOMASELLI 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	208600000X	Surgery Physician	ME49877	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00413913	OTHER	FL	RAILROAD MEDICARE
5	110027564	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P0004906	OTHER	FL	FLORIDA HEALTHCARE PLUS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	13704	OTHER	FL	WELLCARE

General Provider Information

NPI Number	:	1518054527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BETH TOMASELLI MD

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:	MANAGED CARE DEPT.
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1412
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	1283 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-8314
Country	:	US
Telephone Number	:	954-345-2718
Fax Number	:	954-753-2683

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	06/15/2016

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