MEDICARE: MR. THOMAS CAMMERINO AA

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	367H00000X	Anesthesiologist Assistant		MO

General Provider Information

NPI Number	:	1356297667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS CAMMERINO AA

Provider Business Mailing Address
First Line	:	339 CONSORT DR
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-4439
Country	:	US
Telephone Number	:	636-386-9224
Fax Number	:	636-386-7679

Provider Business Practice Location Address
First Line	:	615 S NEW BALLAS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8221
Country	:	US
Telephone Number	:	636-386-9224
Fax Number	:	636-386-7679

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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