1275575748 NPI number — THOMAS R. LEDDY, M.D.,LLC

Table of content: (NPI 1275575748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275575748 NPI number — THOMAS R. LEDDY, M.D.,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS R. LEDDY, M.D.,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275575748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
390 TOLL GATE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-4326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-732-2662
Provider Business Mailing Address Fax Number:
401-732-2669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
390 TOLL GATE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-4326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-732-2662
Provider Business Practice Location Address Fax Number:
401-732-2669
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEDDY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
RAYMOND
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
401-732-2662

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MD04438 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001291 . This is a "BLUE CHIP COMMERCIAL" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9000459 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08-00128 . This is a "UNITED HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 004438 . This is a "TUFTS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 459-4 . This is a "BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: P-12018674 . This is a "MULTIPLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0138733 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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