Healthcare Provider Details

I. General information

NPI: 1245625045
Provider Name (Legal Business Name): LINCOLN P TIRPAECK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD
WARWICK RI
02886-2770
US

IV. Provider business mailing address

455 TOLL GATE ROAD PRC AND CREDENTIALING
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-0641
  • Fax: 401-273-2919
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberDO01074
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: