MEDICARE: DR. THOMAS ROSS JARVIS 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	282N00000X	General Acute Care Hospital	P89270	NY

General Provider Information

NPI Number	:	1558701946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS ROSS JARVIS M.D.

Provider Business Mailing Address
First Line	:	1330 1ST AVE
Second Line	:	APT 724
City	:	NEW YORK
State	:	NY
Zip	:	10021-4742
Country	:	US
Telephone Number	:	347-974-3866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 1ST AVE
Second Line	:	APT 724
City	:	NEW YORK
State	:	NY
Zip	:	10021-4742
Country	:	US
Telephone Number	:	347-974-3866
Fax Number	:

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

Provider Enumeration Date	:	06/28/2013
Last Update Date	:	06/28/2013

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