Provider Demographics
NPI:1821032715
Name:VERME, THOMAS B (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:VERME
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 1:150 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1238
Mailing Address - Country:US
Mailing Address - Phone:315-331-7741
Mailing Address - Fax:315-331-0566
Practice Address - Street 1:150 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1238
Practice Address - Country:US
Practice Address - Phone:315-331-7741
Practice Address - Fax:315-331-0566
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355266Medicaid
NYRA9301Medicare ID - Type Unspecified
NY00355266Medicaid