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General NPI Number Information
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NPI Number | 1174515209
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Entity Type | Individual
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Provider Name | THOMAS P MCBRIDE RPA C
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 07/19/2024
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Provider Practice Location Address
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Address Line | 80 E MAIN ST STE 2A
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City | CANTON
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State | NY
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Zip | 13617-1450
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Country | US
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Telephone | 157-142-5593
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Fax | 315-386-3056
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Provider Business Mailing Address
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Address Line | 100 METROPOLITAN PARK DR STE 100
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City | LIVERPOOL
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State | NY
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Zip | 13088-7112
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Country | US
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Telephone | 315-870-9369
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Fax | 315-870-9364
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 008919-1
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License Number State | NY
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