Provider Demographics
NPI:1053332130
Name:TOMAR, SUPRIYA (MD)
Entity Type:Individual
Prefix:
First Name:SUPRIYA
Middle Name:
Last Name:TOMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 N FLAGLER DR
Mailing Address - Street 2:SUITE 3900
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3404
Mailing Address - Country:US
Mailing Address - Phone:561-805-9399
Mailing Address - Fax:561-805-9866
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:SUITE 3900
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-805-9399
Practice Address - Fax:561-805-9866
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88868207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI06443Medicare UPIN
FLU2162YMedicare ID - Type Unspecified