Healthcare Provider Details

I. General information

NPI: 1508084716
Provider Name (Legal Business Name): TERRANCE TIMOTHY HEALEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 METRO CENTER BOULEVARD SUITE 2000
WARWICK RI
02886
US

IV. Provider business mailing address

125 METRO CENTER BOULEVARD SUITE 2000
WARWICK RI
02886
US

V. Phone/Fax

Practice location:
  • Phone: 401-432-2520
  • Fax: 401-921-9212
Mailing address:
  • Phone: 401-432-2520
  • Fax: 401-921-9212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD11935
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: