Provider Demographics
NPI:1477540185
Name:MILLERICK, THOMAS JOSEPH JR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:MILLERICK
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:725 RESERVOIR AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4451
Mailing Address - Country:US
Mailing Address - Phone:401-829-4446
Mailing Address - Fax:401-829-4434
Practice Address - Street 1:725 RESERVOIR AVE STE 103
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4451
Practice Address - Country:US
Practice Address - Phone:401-829-4446
Practice Address - Fax:401-829-4434
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI04-00378OtherUNITED HEALTH CARE
RI050483739OtherGREAT WEST HEALTH CARE
RI12277884OtherMULTI PLAN
RI7057225Medicaid
RI2046289OtherHEALTH CARE VALUE MGT
RI2239332OtherAETNA
RI29311-0OtherBCBS OF RI
RI709003943OtherMEDICARE GROUP
RI200893OtherBLUE CHIP
RI050483739OtherHEALTH NET / TRI CARE
RI3888906OtherCIGNA
RI302210OtherTUFTS HEALTH PLAN
RI65228OtherHAVARD HEALTH PLAN
RI29311-0OtherBCBS OF RI
RI7057225Medicaid
RI04-00378OtherUNITED HEALTH CARE