Healthcare Provider Details

I. General information

NPI: 1972746550
Provider Name (Legal Business Name): POLLY E. LEONARD, D.O., LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 TOLL GATE RD SUITE 203
WARWICK RI
02886-4326
US

IV. Provider business mailing address

390 TOLL GATE RD STE 203
WARWICK RI
02886-4326
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-2031
  • Fax: 888-948-3254
Mailing address:
  • Phone: 401-732-2031
  • Fax: 888-948-3254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. POLLY LEONARD
Title or Position: OWNER/DOCTOR
Credential: D.O.
Phone: 401-732-2031