Provider Demographics
NPI:1669668737
Name:TOMASELLI, ALFRED A III (DO)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:A
Last Name:TOMASELLI
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 45TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2026
Mailing Address - Country:US
Mailing Address - Phone:561-844-4401
Mailing Address - Fax:561-844-4403
Practice Address - Street 1:2151 45TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2026
Practice Address - Country:US
Practice Address - Phone:561-844-4401
Practice Address - Fax:561-844-4403
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8387207V00000X, 208D00000X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8834ZMedicare PIN
FLH76283Medicare UPIN