Healthcare Provider Details

I. General information

NPI: 1144641705
Provider Name (Legal Business Name): THOMAS JOHN DOLAN JR. RNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2013
Last Update Date: 03/20/2022
Certification Date: 03/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 WATERMAN ST STE 202
PROVIDENCE RI
02906-5215
US

IV. Provider business mailing address

245 WATERMAN ST STE 202
PROVIDENCE RI
02906-5215
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-3322
  • Fax:
Mailing address:
  • Phone: 401-273-3322
  • Fax: 401-270-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN02320
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: