Provider Demographics
NPI: | 1013367515 |
---|---|
Name: | THORP, ANDREW THOMAS JR (MD, MBA) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ANDREW |
Middle Name: | THOMAS |
Last Name: | THORP |
Suffix: | JR |
Gender: | M |
Credentials: | MD, MBA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 6 BLACKSTONE VALLEY PL STE 105 |
Mailing Address - Street 2: | |
Mailing Address - City: | LINCOLN |
Mailing Address - State: | RI |
Mailing Address - Zip Code: | 02865-1112 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 401-762-3838 |
Mailing Address - Fax: | 401-762-8252 |
Practice Address - Street 1: | 6 BLACKSTONE VALLEY PL |
Practice Address - Street 2: | |
Practice Address - City: | LINCOLN |
Practice Address - State: | RI |
Practice Address - Zip Code: | 02865-1179 |
Practice Address - Country: | US |
Practice Address - Phone: | 401-762-3838 |
Practice Address - Fax: | 401-762-8252 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2016-06-15 |
Last Update Date: | 2023-06-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
RI | MD19366 | 207RI0011X, 207RC0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CT | 070031 | Medicare PIN |