MEDICARE: ANN MARIE TOMANDL RPA

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	363A00000X	Physician Assistant	10NY1411	NY

General Provider Information

NPI Number	:	1134421886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARIE TOMANDL RPA

Provider Business Mailing Address
First Line	:	7 ELM ST
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-2829
Country	:	US
Telephone Number	:	585-473-9686
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 S CROUSE AVE
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13210-1834
Country	:	US
Telephone Number	:	585-473-9686
Fax Number	:

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

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/01/2010

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