MEDICARE: MARY B TOMASELLI MD 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	2085U0001X	Diagnostic Ultrasound Physician	ME49877	FL
2	208600000X	Surgery Physician	ME49877	FL
3	2085R0202X	Diagnostic Radiology Physician	172064	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DC1290	OTHER	FL	RAIROAD MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	74644	OTHER	FL	BC BS GROUP NUMBER

General Provider Information

NPI Number	:	1902993934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY B TOMASELLI MD PA

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

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	:	954-753-2683
Fax Number	:	954-753-2683

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARY BETH TOMASELLI
Credential	:	MD
Telephone Number	:	954-753-2683

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	09/11/2025

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Directions to “MARY B TOMASELLI MD PA ” Practice Location

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