MEDICARE: DR. THOMAS M SODEMAN 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	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	216342	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	:	1922078559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS M SODEMAN MD

Provider Business Mailing Address
First Line	:	175 COMMUNITY DR
Second Line	:
City	:	MANHASSET
State	:	NY
Zip	:	11030
Country	:	US
Telephone Number	:	516-465-1900
Fax Number	:	516-465-1830

Provider Business Practice Location Address
First Line	:	10 NEVADA DR
Second Line	:
City	:	LAKE SUCCESS
State	:	NY
Zip	:	11042-1114
Country	:	US
Telephone Number	:	516-719-1060
Fax Number	:	516-719-1062

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/08/2007

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