Provider Demographics
NPI:1689631699
Name:LEDDY, THOMAS RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RAYMOND
Last Name:LEDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:390 TOLL GATE RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4326
Mailing Address - Country:US
Mailing Address - Phone:401-732-2662
Mailing Address - Fax:401-732-2669
Practice Address - Street 1:390 TOLL GATE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4326
Practice Address - Country:US
Practice Address - Phone:401-732-2662
Practice Address - Fax:401-732-2669
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD04438207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000459Medicaid
RI9000459Medicaid