Healthcare Provider Details

I. General information

NPI: 1578732053
Provider Name (Legal Business Name): TOMO TARUI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335R PRAIRIE AVE STE 1A
PROVIDENCE RI
02905-2426
US

IV. Provider business mailing address

300 LONGWOOD AVE FEGAN 11
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5685
  • Fax:
Mailing address:
  • Phone: 617-355-2067
  • Fax: 617-730-0282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD18847
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number231470
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD18847
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: