Provider Demographics
NPI:1932163896
Name:PANE, THOMAS ANGELO (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANGELO
Last Name:PANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:224 LONE PINE DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2467
Mailing Address - Country:US
Mailing Address - Phone:561-775-7819
Mailing Address - Fax:561-775-7839
Practice Address - Street 1:875 MILITARY TRL
Practice Address - Street 2:SUITE #210
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5700
Practice Address - Country:US
Practice Address - Phone:561-747-8100
Practice Address - Fax:561-746-0495
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 94792208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I07963Medicare UPIN