Basic Information
| Provider Information | |||||||||
| NPI: | 1073544235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAMATO | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 844658 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752844658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542159704 | ||||||||
| FaxNumber: | 2542159699 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HILLCREST MEDICAL BLVD | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767128897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542022000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35.092950 | OH | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD055447L | PA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | G85983 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 010124336 | VA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 250779 | NY | N | Allopathic & Osteopathic Physicians | Surgery | 208G00000X | MD055447L | PA | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208600000X | 25100 | NE | N | Allopathic & Osteopathic Physicians | Surgery | 208G00000X | G85983 | CA | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 250779 | NY | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 35.092950 | OH | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 25100 | NE | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 010124336 | VA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 0018877440006 | 05 | PA | MEDICAID | 0107441 | 05 | NJ | MEDICAID | 001887744 | 05 | PA | MEDICAID | 10025773500 | 05 | NE | MEDICAID |