Healthcare Provider Details

I. General information

NPI: 1053392829
Provider Name (Legal Business Name): PAUL TOMLJANOVICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON STREETS
BUFFALO NY
14263-0001
US

IV. Provider business mailing address

ELM AND CARLTON STREETS
BUFFALO NY
14263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-2300
  • Fax: 716-845-4341
Mailing address:
  • Phone: 716-845-2300
  • Fax: 716-845-4341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4726681
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number4726681
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: