Healthcare Provider Details

I. General information

NPI: 1972476174
Provider Name (Legal Business Name): IVAN TOMEK MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 INDUSTRIAL AVE STE 130
WILLISTON VT
05495-4449
US

IV. Provider business mailing address

1 KINGSFORD RD
HANOVER NH
03755-2208
US

V. Phone/Fax

Practice location:
  • Phone: 802-698-3762
  • Fax:
Mailing address:
  • Phone: 603-236-9867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IVAN TOMEK
Title or Position: MANAGER
Credential: MD
Phone: 603-236-9867