Healthcare Provider Details

I. General information

NPI: 1720204480
Provider Name (Legal Business Name): THOMAS F DELLA TORRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W RIVER ST SUITE 2A
PROVIDENCE RI
02904-2615
US

IV. Provider business mailing address

148 W RIVER ST STE 2A
PROVIDENCE RI
02904-2615
US

V. Phone/Fax

Practice location:
  • Phone: 401-728-0140
  • Fax: 401-727-1979
Mailing address:
  • Phone: 401-728-0140
  • Fax: 401-727-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD12716
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: