Provider Demographics
NPI:1194822890
Name:THOMAS, TODD ANDREW (PA-C)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:ANDREW
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BERTRAND CHAFFEE HOSPITAL
Mailing Address - Street 2:E 224 MAIN STREET
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141
Mailing Address - Country:US
Mailing Address - Phone:716-201-0055
Mailing Address - Fax:866-898-3409
Practice Address - Street 1:100 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-1111
Practice Address - Country:US
Practice Address - Phone:716-532-8729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006374363A00000X
NY23-006374363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006374OtherPA NYS LICENSE
NY02936510Medicaid