Provider Demographics
NPI:1295949964
Name:TOMCIK, COLLEEN B (MD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:B
Last Name:TOMCIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:JUDE
Other - Last Name:BEVEVINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 278984
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-1200
Mailing Address - Fax:585-756-5189
Practice Address - Street 1:919 WESTFALL RD
Practice Address - Street 2:BLDG. C, SUITE 220
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2638
Practice Address - Country:US
Practice Address - Phone:585-275-1200
Practice Address - Fax:585-756-5189
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062094A2084N0400X
OH0902492084N0400X
NY2853152084N0400X
OH35.0902492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000225117OtherUNISON
OHP00430594OtherRAILROAD MEDICARE
OH000000532715OtherANTHEM
OH2764129Medicaid
OH9442078OtherAETNA
OH751189OtherBUCKEYE MEDICAID
OH415044OtherWELLCARE MEDICAID
OH2764129Medicaid