Basic Information
| Provider Information | |||||||||
| NPI: | 1154318194 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MITROS | ||||||||
| FirstName: | TOM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 68 S SERVICE RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | MELVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117472354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169453347 | ||||||||
| FaxNumber: | 5169453131 | ||||||||
| Practice Location | |||||||||
| Address1: | 23 N WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | BOYERTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 195121467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103678844 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | CI006035 | DE | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | MD025772E | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | C1-0006035 | DE | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 25MA06549800 | NJ | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | MD025772E | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.