Provider Demographics
NPI:1972476174
Name:IVAN TOMEK MD PLLC
Entity type:Organization
Organization Name:IVAN TOMEK MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-236-9867
Mailing Address - Street 1:1 KINGSFORD RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-2208
Mailing Address - Country:US
Mailing Address - Phone:603-236-9867
Mailing Address - Fax:
Practice Address - Street 1:426 INDUSTRIAL AVE STE 130
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-4449
Practice Address - Country:US
Practice Address - Phone:802-698-3762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty