Healthcare Provider Details

I. General information

NPI: 1275575748
Provider Name (Legal Business Name): THOMAS R. LEDDY, M.D.,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 TOLL GATE RD
WARWICK RI
02886-4326
US

IV. Provider business mailing address

390 TOLL GATE RD
WARWICK RI
02886-4326
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-2662
  • Fax: 401-732-2669
Mailing address:
  • Phone: 401-732-2662
  • Fax: 401-732-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD04438
License Number StateRI

VIII. Authorized Official

Name: DR. THOMAS RAYMOND LEDDY
Title or Position: OWNER
Credential: M.D.
Phone: 401-732-2662