Healthcare Provider Details

I. General information

NPI: 1205880911
Provider Name (Legal Business Name): EARLANDO OLIVER THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2337 RIDGEWAY AVE
ROCHESTER NY
14626
US

IV. Provider business mailing address

2337 RIDGEWAY AVE
ROCHESTER NY
14626-4111
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-6680
  • Fax: 585-225-3472
Mailing address:
  • Phone: 585-225-6680
  • Fax: 585-225-3472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number226721
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number226721
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: