Provider Demographics
NPI:1205148798
Name:PETER TOMASELLO D O P A
Entity type:Organization
Organization Name:PETER TOMASELLO D O P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOMASELLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:954-454-9091
Mailing Address - Street 1:PO BOX 220371
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33022-0371
Mailing Address - Country:US
Mailing Address - Phone:954-454-9091
Mailing Address - Fax:954-454-1711
Practice Address - Street 1:1724 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4611
Practice Address - Country:US
Practice Address - Phone:954-454-9091
Practice Address - Fax:954-454-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty