Healthcare Provider Details

I. General information

NPI: 1114211109
Provider Name (Legal Business Name): TIMOTHY POORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 N MAIN ST
PROVIDENCE RI
02904-5719
US

IV. Provider business mailing address

35 FESSENDEN RD
BARRINGTON RI
02806-4711
US

V. Phone/Fax

Practice location:
  • Phone: 401-415-4200
  • Fax:
Mailing address:
  • Phone: 661-904-4553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD18645
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: