MEDICARE: DR. BRAULIO FEDERICO COSME-THORMANN MD

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	207RC0000X	Cardiovascular Disease Physician	255151	NY

General Provider Information

NPI Number	:	1578669214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAULIO FEDERICO COSME-THORMANN MD

Provider Business Mailing Address
First Line	:	8563 212TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-1340
Country	:	US
Telephone Number	:	718-217-8482
Fax Number	:

Provider Business Practice Location Address
First Line	:	8211 37TH AVE
Second Line	:	5TH FLOOR
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7001
Country	:	US
Telephone Number	:	718-899-5900
Fax Number	:	718-899-2134

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	11/02/2009

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