Healthcare Provider Details

I. General information

NPI: 1316019292
Provider Name (Legal Business Name): SEBASTIAN TROMBATORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TOLL GATE RD SUITE 305
WARWICK RI
02886
US

IV. Provider business mailing address

300 TOLL GATE RD SUITE 305
WARWICK RI
02886
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-6611
  • Fax: 401-738-0013
Mailing address:
  • Phone: 401-738-6611
  • Fax: 401-738-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberRI6797
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberRI6797
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: