Provider Demographics
NPI:1982602413
Name:MEOLA, THOMAS JR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:MEOLA
Suffix:JR
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 1:1410 BROADWAY RM 703
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-9365
Mailing Address - Country:US
Mailing Address - Phone:212-481-7541
Mailing Address - Fax:212-599-4554
Practice Address - Street 1:1410 BROADWAY RM 703
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-9365
Practice Address - Country:US
Practice Address - Phone:212-481-7541
Practice Address - Fax:212-599-4554
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180823207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG03702Medicare UPIN
NY00D981Medicare ID - Type Unspecified