Healthcare Provider Details

I. General information

NPI: 1407830334
Provider Name (Legal Business Name): THOMAS ALLEN ROESLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST PHYSICIAN'S OFFICE BLDG., # 122
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST APC 978
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4515
  • Fax: 401-444-7018
Mailing address:
  • Phone: 401-444-4318
  • Fax: 401-444-7865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD09304
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD09304
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: