Healthcare Provider Details

I. General information

NPI: 1174528145
Provider Name (Legal Business Name): THOMAS V SMALLMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CHESTNUT CIR
SKANEATELES NY
13152
US

IV. Provider business mailing address

3 CHESTNUT CIR
SKANEATELES NY
13152-1301
US

V. Phone/Fax

Practice location:
  • Phone: 315-415-0612
  • Fax: 315-554-8185
Mailing address:
  • Phone: 315-415-0612
  • Fax: 315-554-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number216518-1
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number216518
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: