Provider Demographics
NPI:1508980574
Name:TOMASULO, RANDI D (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDI
Middle Name:D
Last Name:TOMASULO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 MAIN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1080
Mailing Address - Country:US
Mailing Address - Phone:203-838-4000
Mailing Address - Fax:203-845-9535
Practice Address - Street 1:761 MAIN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1080
Practice Address - Country:US
Practice Address - Phone:203-838-4000
Practice Address - Fax:203-845-9535
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045676207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism