MEDICARE: THOMAS A BERSANI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	170204	NY
2	207W00000X	Ophthalmology Physician	170204	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	820000028	OTHER		RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	820000028	OTHER		RRMCR

General Provider Information

NPI Number	:	1083614226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS A BERSANI MD

Provider Business Mailing Address
First Line	:	PO BOX 2003
Second Line	:
City	:	EAST SYRACUSE
State	:	NY
Zip	:	13057-4503
Country	:	US
Telephone Number	:	315-446-3904
Fax Number	:	315-445-2936

Provider Business Practice Location Address
First Line	:	3400 VICKERY RD
Second Line	:	SUITE A
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-4540
Country	:	US
Telephone Number	:	315-422-3937
Fax Number	:	315-422-4432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	03/19/2025

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Directions to “ THOMAS A BERSANI MD” Practice Location

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