Provider Demographics
NPI:1275605206
Name:TOMASKI, SHARON MARIE (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:TOMASKI
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 1:620 W GROVE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4425
Mailing Address - Country:US
Mailing Address - Phone:870-864-3352
Mailing Address - Fax:870-864-3255
Practice Address - Street 1:620 W GROVE ST STE 201
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4425
Practice Address - Country:US
Practice Address - Phone:870-864-3352
Practice Address - Fax:870-864-3255
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39311207YP0228X, 207YX0905X
OH35.120287207YX0905X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01262055OtherRAILROAD MEDICARE - MHCPI
OH0074130Medicaid
WV3810024380Medicaid
CO85882046Medicaid
OHP01262055OtherRAILROAD MEDICARE - MHCPI
CO85882046Medicaid
WV3810024380Medicaid
OHH133552Medicare PIN
COP00054658Medicare PIN