Provider Demographics
NPI:1164599858
Name:THOMAS DAVID PULEO, MD, LLC
Entity Type:Organization
Organization Name:THOMAS DAVID PULEO, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:PULEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-944-4411
Mailing Address - Street 1:1220 PONTIAC AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4456
Mailing Address - Country:US
Mailing Address - Phone:401-944-4411
Mailing Address - Fax:401-944-4412
Practice Address - Street 1:1220 PONTIAC AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-4456
Practice Address - Country:US
Practice Address - Phone:401-944-4411
Practice Address - Fax:401-944-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11592208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty