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General NPI Number Information
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NPI Number | 1164599858
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Entity Type | Organization
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Legal Business Name | THOMAS DAVID PULEO, MD, LLC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1220 PONTIAC AVE SUITE 302
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City | CRANSTON
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State | RI
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Zip | 02920-4456
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Country | US
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Telephone | 401-944-4411
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Fax | 401-944-4412
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Provider Business Mailing Address
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Address Line | 1220 PONTIAC AVE SUITE 302
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City | CRANSTON
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State | RI
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Zip | 02920-4456
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Country | US
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Telephone | 401-944-4411
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Fax | 401-944-4412
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Authorized Official
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Title or Position | MEMBER
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Name | DR. THOMAS D PULEO
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Credential | MD
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Telephone | 401-944-4411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD11592
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License Number State | RI
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