Individual
DR. THOMAS JEFFERSON VANDERMEER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
750 EAST ADAMS ST., SYRACUSE, NY 13210
(315) 464-1800
(315) 464-6238
Mailing address
251 SALINA MEADOWS PKWY STE 100, SYRACUSE, NY 13212-4516
(315) 464-2000
(315) 464-2010
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
212422-1
NY
208600000X
Surgery Physician
Primary
MD066677L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017090630001
—
PA
05
—
01876677
—
NY
01
—
020046847
RR MEDICARE PIN
PA
01
—
CC9269
RR MEDICARE GROUP
PA
01
—
GU039818
PA MEDICARE GROUP
PA
Enumeration date
02/24/2006
Last updated
03/26/2019
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