Provider Demographics
NPI:1184639775
Name:TOMASOSKI, THERESE K (MD)
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:K
Last Name:TOMASOSKI
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 1:3760 PIPER ST
Mailing Address - Street 2:SUITE 1060
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4665
Mailing Address - Country:US
Mailing Address - Phone:907-212-6522
Mailing Address - Fax:907-212-6593
Practice Address - Street 1:2250 SOUTH WOODWORTH LOOP
Practice Address - Street 2:SUITE 101
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7457
Practice Address - Country:US
Practice Address - Phone:907-761-5900
Practice Address - Fax:907-761-5999
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5385208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD5385Medicaid
AK164084Medicare PIN
AKMD5385Medicaid