Healthcare Provider Details

I. General information

NPI: 1467434175
Provider Name (Legal Business Name): RICHARD J TOMOLONIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 MCGREGOR ST SUITE 3100
MANCHESTER NH
03102-3731
US

IV. Provider business mailing address

87 MCGREGOR ST SUITE 3100
MANCHESTER NH
03102-3731
US

V. Phone/Fax

Practice location:
  • Phone: 603-627-1887
  • Fax: 603-627-1890
Mailing address:
  • Phone: 603-627-1887
  • Fax: 603-627-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number13132
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number13132
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: