Provider Demographics
NPI:1063404937
Name:TOMASSI, FREDERICK J (DPM)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:J
Last Name:TOMASSI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1621
Mailing Address - Country:US
Mailing Address - Phone:814-864-2360
Mailing Address - Fax:814-864-2383
Practice Address - Street 1:3901 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1621
Practice Address - Country:US
Practice Address - Phone:814-864-2360
Practice Address - Fax:814-864-2383
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002663L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA208378OtherUPMC
PA315569OtherHEALTH AMERICA
PA4099240OtherAETNA PPO
PA64728OtherMEDPLUS
PA10937716OtherUNITED HEALTHCARE
PA1500186OtherGATEWAY
PA443626OtherHIGHMARK BLUE SHIELD
PA748412OtherAETNA HMO
PA208378OtherUPMC
PA443626Medicare ID - Type Unspecified