Provider Demographics
NPI:1669466470
Name:DELLATORRE, THOMAS D (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:DELLATORRE
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 1:333 SCHOOL ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5334
Mailing Address - Country:US
Mailing Address - Phone:401-728-0140
Mailing Address - Fax:401-727-1979
Practice Address - Street 1:333 SCHOOL ST
Practice Address - Street 2:SUITE 302
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5334
Practice Address - Country:US
Practice Address - Phone:401-728-0140
Practice Address - Fax:401-727-1979
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD04411174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000282Medicaid
049000282Medicare ID - Type Unspecified
C90816Medicare UPIN