Provider Demographics
NPI:1982720926
Name:TOMAKA, EDWIN B (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:B
Last Name:TOMAKA
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 1:701 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-1507
Mailing Address - Country:US
Mailing Address - Phone:716-903-6367
Mailing Address - Fax:716-662-7048
Practice Address - Street 1:701 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1507
Practice Address - Country:US
Practice Address - Phone:716-903-6367
Practice Address - Fax:716-662-7048
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077361208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery