Individual
MARY BETH TOMASELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1283 N UNIVERSITY DR, CORAL SPRINGS, FL 33071-8314
(954) 345-2718
(954) 753-2683
Mailing address
2234 COLONIAL BLVD, MANAGED CARE DEPT., FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME49877
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
045418400
—
FL
01
—
110027564
RAILROAD MEDICARE
FL
01
—
13704
WELLCARE
FL
01
—
P0004906
FLORIDA HEALTHCARE PLUS
FL
01
—
P00413913
RAILROAD MEDICARE
FL
Enumeration date
10/10/2006
Last updated
06/15/2016
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