Provider Demographics
NPI:1275543878
Name:JEAN, THOMAS WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WILLIAM
Last Name:JEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 CHALKSTONE AVE
Mailing Address - Street 2:VA MEDICAL CENTER
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4799
Mailing Address - Country:US
Mailing Address - Phone:401-273-7100
Mailing Address - Fax:401-525-2591
Practice Address - Street 1:830 CHALKSTONE AVE
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4799
Practice Address - Country:US
Practice Address - Phone:401-273-7100
Practice Address - Fax:401-525-2591
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD06602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine