MEDICARE: DR. EARLANDO OLIVER THOMAS M.D.

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	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	226721	NY
2	207V00000X	Obstetrics & Gynecology Physician	226721	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00043558	OTHER	NY	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1205880911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EARLANDO OLIVER THOMAS M.D.

Provider Business Mailing Address
First Line	:	2337 RIDGEWAY AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4111
Country	:	US
Telephone Number	:	585-225-6680
Fax Number	:	585-225-3472

Provider Business Practice Location Address
First Line	:	2337 RIDGEWAY AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626
Country	:	US
Telephone Number	:	585-225-6680
Fax Number	:	585-225-3472

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	05/25/2021

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