Provider Demographics
NPI:1811284714
Name:WOLOSZYN, TOMASZ B (MD)
Entity type:Individual
Prefix:
First Name:TOMASZ
Middle Name:B
Last Name:WOLOSZYN
Suffix:
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 1:2223 W STATE ST
Mailing Address - Street 2:STE 110
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1938
Mailing Address - Country:US
Mailing Address - Phone:716-450-0944
Mailing Address - Fax:
Practice Address - Street 1:2223 W STATE ST
Practice Address - Street 2:STE 110
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760
Practice Address - Country:US
Practice Address - Phone:716-450-0944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03374256Medicaid
NYJ400168959OtherMEDICARE PTAN
NYJ400051789Medicare PIN