Provider Demographics
NPI:1316019292
Name:TROMBATORE, SEBASTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:
Last Name:TROMBATORE
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 1:300 TOLL GATE RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-738-6611
Mailing Address - Fax:401-738-0013
Practice Address - Street 1:300 TOLL GATE RD
Practice Address - Street 2:SUITE 305
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-738-6611
Practice Address - Fax:401-738-0013
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI6797208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9004732Medicaid
RI9004732Medicaid
RI007058406Medicare ID - Type Unspecified