Healthcare Provider Details

I. General information

NPI: 1568634566
Provider Name (Legal Business Name): SEBASTIAN TROMBATORE, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TOLL GATE RD SUITE 305
WARWICK RI
02886-4416
US

IV. Provider business mailing address

300 TOLL GATE RD SUITE 305
WARWICK RI
02886-4416
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 TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number6797
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6797
License Number StateRI

VIII. Authorized Official

Name: DR. SEBASTIAN TROMBATORE
Title or Position: OWNER
Credential: M.D.
Phone: 401-738-6611