Provider Demographics
NPI:1255335907
Name:ELMER, THOMAS ROBERT VI (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROBERT
Last Name:ELMER
Suffix:VI
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 1:1837 WINTER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1053
Mailing Address - Country:US
Mailing Address - Phone:716-864-5479
Mailing Address - Fax:716-564-2060
Practice Address - Street 1:2825 NIAGARA FALLS BLVD
Practice Address - Street 2:STE 130
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2021
Practice Address - Country:US
Practice Address - Phone:716-564-2020
Practice Address - Fax:716-564-2060
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224822-2174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161578122OtherEMPIRE - UNITED HEALTHCAR
NY02286299Medicaid
NY161578122OtherNOVA
NY161578122OtherAMERISIGHT
NY251744484OtherNOVA
NY161578122OtherNORTH AMERICAN PREFERRED
NY251744484OtherEMPIRE - UNITED HEALTHCAR
NYP00225786OtherMEDICARE RAILROAD
NY00011122301OtherUNIVERA
NY161578122OtherVISION LCA
NY251744484OtherNORTH AMERICAN PREFERRED
NYRA5459Medicare PIN
NYRA5458Medicare PIN
NY251744484OtherNORTH AMERICAN PREFERRED