Provider Demographics
NPI:1245236918
Name:RAIMONDO, THOMAS JOSEPH
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:RAIMONDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3655
Mailing Address - Country:US
Mailing Address - Phone:401-467-6257
Mailing Address - Fax:401-785-1191
Practice Address - Street 1:1050 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3655
Practice Address - Country:US
Practice Address - Phone:401-467-6257
Practice Address - Fax:401-785-1191
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00347207RP1001X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003083Medicaid
F00336Medicare UPIN
119003083Medicare ID - Type Unspecified