Provider Demographics
NPI:1881604940
Name:TOLL GATE RADIOLOGY INC
Entity type:Organization
Organization Name:TOLL GATE RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRUZZESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-738-3100
Mailing Address - Street 1:215 TOLL GATE RD
Mailing Address - Street 2:STE 109
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4458
Mailing Address - Country:US
Mailing Address - Phone:401-738-3100
Mailing Address - Fax:401-738-8505
Practice Address - Street 1:300 TOLL GATE RD
Practice Address - Street 2:STE 101A, STE 102
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4416
Practice Address - Country:US
Practice Address - Phone:401-738-3100
Practice Address - Fax:401-738-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRAD00662085N0904X, 2085U0001X, 2085R0204X, 2085D0003X, 2085B0100X, 2085N0700X, 2085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Single Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9001570Medicaid
RI1570-5OtherBCBS KENT HOSP PROVIDER N
RI2188604OtherAETNA OFFICE PROVIDER NO
RI2203OtherNEIGHBORHOOD H PLAN PROVI
RI1742251OtherUNITED HEALTHCARE
RICD2379OtherRAILROAD MEDICARE
RI9001198Medicaid
RI1198-5OtherBCBS OFFICE PROVIDER NO
RI703058OtherTUFTS HEALTH PLAN
RI50356624OtherUNICARE LIFE AND HLTH INS
RI5144133OtherAETNA KENT HOSPITAL PROV
RI68453OtherCIGNA
RI1742251OtherUNITED HEALTHCARE
RICD2379OtherRAILROAD MEDICARE
RI50356624OtherUNICARE LIFE AND HLTH INS