MEDICARE: THOMAS TEDESCHI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	PA01565	RI

General Provider Information

NPI Number	:	1114551371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS TEDESCHI

Provider Business Mailing Address
First Line	:	1455 ASHLAND CIR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509-1203
Country	:	US
Telephone Number	:	757-567-7479
Fax Number	:

Provider Business Practice Location Address
First Line	:	1524 ATWOOD AVE STE LL6
Second Line	:
City	:	JOHNSTON
State	:	RI
Zip	:	02919-3228
Country	:	US
Telephone Number	:	401-331-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2020
Last Update Date	:	03/18/2026

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Directions to “ THOMAS TEDESCHI ” Practice Location

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