Healthcare Provider Details

I. General information

NPI: 1164599858
Provider Name (Legal Business Name): THOMAS DAVID PULEO, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 PONTIAC AVE SUITE 302
CRANSTON RI
02920-4456
US

IV. Provider business mailing address

1220 PONTIAC AVE SUITE 302
CRANSTON RI
02920-4456
US

V. Phone/Fax

Practice location:
  • Phone: 401-944-4411
  • Fax: 401-944-4412
Mailing address:
  • Phone: 401-944-4411
  • Fax: 401-944-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD11592
License Number StateRI

VIII. Authorized Official

Name: DR. THOMAS D PULEO
Title or Position: MEMBER
Credential: MD
Phone: 401-944-4411