Healthcare Provider Details

I. General information

NPI: 1659758977
Provider Name (Legal Business Name): PETER P. TOMAIOLO MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WINTHROP ST
WORCESTER MA
01604-4435
US

IV. Provider business mailing address

10 WINTHROP ST
WORCESTER MA
01604-4435
US

V. Phone/Fax

Practice location:
  • Phone: 508-755-6129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PETER TOMAIOLO
Title or Position: PRESIDENT
Credential:
Phone: 508-755-6129