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NPI Code Detail

MEDICARE: DR. THOMAS E. SKOLODA PH.D.

MEDICARE: DR. THOMAS E. SKOLODA PH.D.
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
1103T00000XPsychologistPY 6654FL

General Provider Information

NPI Number : 1629194808
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS E. SKOLODA PH.D.
Provider Business Mailing Address
First Line : PO BOX 872
Second Line : 775 NORTH SHORE DRIVE
City : ANNA MARIA
State : FL
Zip : 34216-0872
Country : US
Telephone Number : 941-778-4184
Fax Number :
Provider Business Practice Location Address
First Line : 5000 LAKEWOOD RANCH BLVD
Second Line :
City : BRADENTON
State : FL
Zip : 34211-4909
Country : US
Telephone Number : 941-756-0690
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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