Provider Demographics
NPI:1205828068
Name:WORMER, THOMAS A (MD)
Entity Type:Individual
Prefix:MS
First Name:THOMAS
Middle Name:A
Last Name:WORMER
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 1:335 PARRISH ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1728
Mailing Address - Country:US
Mailing Address - Phone:585-393-2888
Mailing Address - Fax:585-396-9275
Practice Address - Street 1:335 PARRISH ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1728
Practice Address - Country:US
Practice Address - Phone:585-393-2888
Practice Address - Fax:585-396-9275
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168688208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMD4041OtherPREFERRED CARE
NY01059865Medicaid
NY9865OtherBLUE SHIELD
NY16024UMedicare ID - Type Unspecified
NY01059865Medicaid