MEDICARE: MR. THOMAS P MCBRIDE RPA C

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	008919-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174515209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS P MCBRIDE RPA C

Provider Business Mailing Address
First Line	:	100 METROPOLITAN PARK DR STE 100
Second Line	:
City	:	LIVERPOOL
State	:	NY
Zip	:	13088-7112
Country	:	US
Telephone Number	:	315-870-9369
Fax Number	:	315-870-9364

Provider Business Practice Location Address
First Line	:	80 E MAIN ST STE 2A
Second Line	:
City	:	CANTON
State	:	NY
Zip	:	13617-1450
Country	:	US
Telephone Number	:	157-142-5593
Fax Number	:	315-386-3056

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/19/2024

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