Provider Demographics
NPI:1568634566
Name:SEBASTIAN TROMBATORE, M.D., LLC
Entity Type:Organization
Organization Name:SEBASTIAN TROMBATORE, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TROMBATORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-738-6611
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:02886-4416
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:02886-4416
Practice Address - Country:US
Practice Address - Phone:401-738-6611
Practice Address - Fax:401-738-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI6797208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9004732Medicaid