Thomas J Davidson IV Wny LLC

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

THOMAS J DAVIDSON IV WNY LLC

Practice address

2700 Sheridan Dr
Tonawanda, NY 14150-9462

Phone

(251) 747-4401

NPI assigned

Jul 18, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Thomas J Davidson IV, DPMNPI 1295171858

Title

Doctor of Podiatric Medicine, Owner

Phone

(251) 747-4401

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thomas John Davidson IV, DPM

  • Primary Podiatric Medicine Podiatrist
  • Roanoke, VA
  • NPI 1295171858

  NY

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1013697770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 SHERIDAN DR",
            "city": "TONAWANDA",
            "state": "NY",
            "postal_code": "141509462",
            "telephone_number": "251-747-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 SHERIDAN DR",
            "city": "TONAWANDA",
            "state": "NY",
            "postal_code": "141509462",
            "telephone_number": "251-747-4401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS J DAVIDSON IV WNY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-18",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DOCTOR OF PODIATRIC MEDICINE, OWNER",
        "authorized_official_telephone_number": "251-747-4401",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph S. Testa, M.D.
• Antoniette Thavarajah, OD
• The Foot & Ankle Podiatry,PC
• The Foot and Ankle Podiatry PC
• Cynthia Thiebolt
• Jacinda Thomas, MSW
• Michael Anthony Tirone, PT
• Patricia Todd
• Rachel Leigh Todtenhagen, PHARM.D.
• Jessica Lynn Tomasello, RDN

• Podiatrist in Tonawanda, NY
• Providers in Tonawanda, NY by specialty
• Podiatrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.