Healthcare Provider Details

I. General information

NPI: 1902993934
Provider Name (Legal Business Name): MARY B TOMASELLI MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 N UNIVERSITY DR
CORAL SPRINGS FL
33071-8314
US

IV. Provider business mailing address

1283 N UNIVERSITY DR
CORAL SPRINGS FL
33071-8314
US

V. Phone/Fax

Practice location:
  • Phone: 954-753-2683
  • Fax: 954-753-2683
Mailing address:
  • Phone: 954-753-2683
  • Fax: 954-753-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number172064
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberME49877
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME49877
License Number StateFL

VIII. Authorized Official

Name: MARY BETH TOMASELLI
Title or Position: PRESIDENT
Credential: MD
Phone: 954-753-2683