Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A1493801 | NY |
N | 111NI0900X | Internist | A1493801 | NY |
Y | 207RA0401X | Internist - Addiction Medicine | A149380 | NY |
NPI | 1497728737 |
---|---|
Provider Name | Thomas C Small |
First Address | Williamsville, NY 14221-7386 |
Second Address | Williamsville, NY 14221-7386 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 09/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0050859908 | BC WNY (01) | NY |
00738138 | (05) | NY |
0408004 | INDEPENDENT HEALTH INS (01) | |
B71709 | (02) |