Provider Demographics
NPI:1336130665
Name:TSOURMAS, NICHOLAS F (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:F
Last Name:TSOURMAS
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:PO BOX 8738
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8738
Mailing Address - Country:US
Mailing Address - Phone:512-451-1969
Mailing Address - Fax:
Practice Address - Street 1:2500 W WILLIAM CANNON DR
Practice Address - Street 2:STE 401
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5257
Practice Address - Country:US
Practice Address - Phone:512-451-1969
Practice Address - Fax:512-458-2327
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6241207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135744404Medicaid
TX8L18601Medicare PIN
TX135744404Medicaid
TX83J886Medicare PIN