Provider Demographics
NPI:1174528145
Name:SMALLMAN, THOMAS V (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:V
Last Name:SMALLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CHESTNUT CIR
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-1301
Mailing Address - Country:US
Mailing Address - Phone:315-415-0612
Mailing Address - Fax:315-554-8185
Practice Address - Street 1:3 CHESTNUT CIR
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152
Practice Address - Country:US
Practice Address - Phone:315-415-0612
Practice Address - Fax:315-554-8185
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM216518-1207XX0005X
NY216518207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01713895Medicaid
NY01713895Medicaid
NYJ400009618Medicare PIN