Provider Demographics
NPI:1023030251
Name:DILAMARTER, THOMAS I (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:I
Last Name:DILAMARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-260-1593
Mailing Address - Fax:716-771-3903
Practice Address - Street 1:3045 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1209
Practice Address - Country:US
Practice Address - Phone:716-260-1593
Practice Address - Fax:716-771-3903
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080178890OtherRAILROAD MEDICARE
NY040426001423OtherFIDELIS
NY00010303702OtherUNIVERA
NY000524712003OtherBLUE CROSS OF WNY
NY0109593OtherINDEPENDENT HEATLH
F69414Medicare UPIN
NYDD4677Medicare ID - Type UnspecifiedMEDICARE PART B