Individual
TOMMY JOHN MEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4900 BROAD RD, SYRACUSE, NY 13215-2265
(315) 492-5535
(315) 492-5222
Mailing address
4900 BROAD RD, SYRACUSE, NY 13215-2265
(315) 492-5535
(315) 492-5222
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
199608-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01585886
—
NY
Enumeration date
07/19/2006
Last updated
04/08/2011
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