Provider Demographics
NPI:1275575748
Name:THOMAS R. LEDDY, M.D.,LLC
Entity Type:Organization
Organization Name:THOMAS R. LEDDY, M.D.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:LEDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-732-2662
Mailing Address - Street 1:390 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4326
Mailing Address - Country:US
Mailing Address - Phone:401-732-2662
Mailing Address - Fax:401-732-2669
Practice Address - Street 1:390 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4326
Practice Address - Country:US
Practice Address - Phone:401-732-2662
Practice Address - Fax:401-732-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD04438207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI001291OtherBLUE CHIP COMMERCIAL
RI9000459Medicaid
RI08-00128OtherUNITED HEALTH
RI004438OtherTUFTS
RI459-4OtherBLUE SHIELD
RIP-12018674OtherMULTIPLAN
RI0138733OtherCIGNA
RIP-12018674OtherMULTIPLAN
RI9000459Medicaid