Provider Demographics
NPI:1518052315
Name:OBST, THOMAS E (PHD, CRNA)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:OBST
Suffix:
Gender:M
Credentials:PHD, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 MCNAIR RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3759
Mailing Address - Country:US
Mailing Address - Phone:716-829-2410
Mailing Address - Fax:716-634-9268
Practice Address - Street 1:515 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1513
Practice Address - Country:US
Practice Address - Phone:716-372-2600
Practice Address - Fax:716-373-7191
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271264367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12240GMedicare ID - Type Unspecified
NYG75381Medicare ID - Type Unspecified
NYS26624Medicare UPIN
NYRA0275Medicare ID - Type Unspecified