Provider Demographics
NPI:1902993934
Name:MARY B TOMASELLI MD PA
Entity Type:Organization
Organization Name:MARY B TOMASELLI MD PA
Other - Org Name:COMPREHENSIVE BREAST CENTER OF CORAL SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:TOMASELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-753-2683
Mailing Address - Street 1:1283 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8314
Mailing Address - Country:US
Mailing Address - Phone:954-753-2683
Mailing Address - Fax:954-753-2683
Practice Address - Street 1:1283 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8314
Practice Address - Country:US
Practice Address - Phone:954-753-2683
Practice Address - Fax:954-753-2683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1720642085R0202X
FLME498772085U0001X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74644OtherBC BS GROUP NUMBER
FLDC1290OtherRAIROAD MEDICARE GROUP #
FLK5258Medicare UPIN