Provider Demographics
NPI:1205996980
Name:SMITH, THOMAS P JR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:SMITH
Suffix:JR
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 1:960 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2332
Mailing Address - Country:US
Mailing Address - Phone:716-674-8502
Mailing Address - Fax:716-674-8504
Practice Address - Street 1:960 CENTER RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2332
Practice Address - Country:US
Practice Address - Phone:716-674-8502
Practice Address - Fax:716-674-8504
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179784NY207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00186734OtherMEDICARE RAILROAD
NY00010169005OtherUNIVERA
NY000511306008OtherCB BCBS
NY01479267Medicaid
NY2109195OtherIHA
NY01479267Medicaid
NY2109195OtherIHA