Provider Demographics
NPI:1194850552
Name:TOMESCH, DONNA (RPAC)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:TOMESCH
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4522
Mailing Address - Country:US
Mailing Address - Phone:845-331-8222
Mailing Address - Fax:845-331-7818
Practice Address - Street 1:26 PEARL ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4522
Practice Address - Country:US
Practice Address - Phone:845-331-8222
Practice Address - Fax:845-331-7818
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0034271363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03542665Medicaid
NY03542665Medicaid