Provider Demographics
NPI:1467687350
Name:FUSCO, THOMAS ARTHUR (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ARTHUR
Last Name:FUSCO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 MAR WALT DR UNIT 100
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6637
Mailing Address - Country:US
Mailing Address - Phone:850-863-2153
Mailing Address - Fax:850-863-2153
Practice Address - Street 1:1034 MAR WALT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6639
Practice Address - Country:US
Practice Address - Phone:850-863-2153
Practice Address - Fax:850-863-8085
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3553213ES0103X
OH36.003605213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006303300Medicaid
FL6505YMedicare PIN