Healthcare Provider Details

I. General information

NPI: 1790705739
Provider Name (Legal Business Name): THOMAS PASCHAL O'TOOLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

IV. Provider business mailing address

220 MOOSEHORN RD
EAST GREENWICH RI
02818-1140
US

V. Phone/Fax

Practice location:
  • Phone: 401-457-3045
  • Fax: 401-525-2549
Mailing address:
  • Phone: 401-457-3045
  • Fax: 401-525-2549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD035019
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: