MEDICARE: OMALLEY & HALL MDS PA

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	207RG0100X	Gastroenterology Physician		NY

General Provider Information

NPI Number	:	1649262981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMALLEY & HALL MDS PA

Provider Business Mailing Address
First Line	:	2650 BAHIA VISTA ST
Second Line	:	SUITE 207
City	:	SARASOTA
State	:	FL
Zip	:	34239-2635
Country	:	US
Telephone Number	:	941-366-8960
Fax Number	:	941-364-9111

Provider Business Practice Location Address
First Line	:	2650 BAHIA VISTA ST
Second Line	:	SUITE 207
City	:	SARASOTA
State	:	FL
Zip	:	34239-2635
Country	:	US
Telephone Number	:	941-366-8960
Fax Number	:	941-364-9111

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	THOMAS ANTHONY OMALLEY
Credential	:	MD
Telephone Number	:	941-366-8960

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/21/2022

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