Provider Demographics
NPI:1477540185
Name:MILLERICK, THOMAS J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:MILLERICK
Suffix:JR
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 1:455 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-737-7000
Mailing Address - Fax:
Practice Address - Street 1:455 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2759
Practice Address - Country:US
Practice Address - Phone:401-737-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI050483739OtherHEALTH NET / TRI CARE
RI200893OtherBLUE CHIP
RI302210OtherTUFTS HEALTH PLAN
RI709003943OtherMEDICARE GROUP
RI7057225Medicaid
RI050483739OtherGREAT WEST HEALTH CARE
RI2239332OtherAETNA
RI29311-0OtherBCBS OF RI
RI3888906OtherCIGNA
RI65228OtherHAVARD HEALTH PLAN
RI12277884OtherMULTI PLAN
RI04-00378OtherUNITED HEALTH CARE
RI2046289OtherHEALTH CARE VALUE MGT
RI29311-0OtherBCBS OF RI
RI7057225Medicaid
RI04-00378OtherUNITED HEALTH CARE