Provider Demographics
NPI:1669414421
Name:AIELLO, THOMAS R (DO)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:R
Last Name:AIELLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 E GENESEE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1752
Mailing Address - Country:US
Mailing Address - Phone:315-475-8401
Mailing Address - Fax:
Practice Address - Street 1:945 E GENESEE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1752
Practice Address - Country:US
Practice Address - Phone:315-475-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111708207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00485052Medicaid
NYRB1581Medicare PIN
NY35068BMedicare PIN
NYB81406Medicare UPIN
NY51137BMedicare PIN