=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134421886
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN MARIE TOMANDL RPA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2010
-----------------------------------------------------
Last Update Date | 12/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 S CROUSE AVE
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13210-1834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-473-9686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 ELM ST
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13021-2829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-473-9686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 10NY1411
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------