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General NPI Number Information
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NPI Number | 1285080945
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Entity Type | Organization
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Legal Business Name | THOMAS R. WALEK, M.D., INC.
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Dates
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Enumeration Date | 05/11/2016
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Last Update Date | 05/11/2016
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Provider Practice Location Address
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Address Line | 200 TOLL GATE RD SUITE 102
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City | WARWICK
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State | RI
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Zip | 02886-4491
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Country | US
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Telephone | 401-738-7659
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Fax | 401-738-6425
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Provider Business Mailing Address
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Address Line | 200 TOLL GATE RD SUITE 102
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City | WARWICK
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State | RI
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Zip | 02886-4491
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Country | US
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Telephone | 401-738-7659
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Fax | 401-738-6425
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KAREN MARIE RODRIGUES
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Credential |
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Telephone | 401-738-7659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | MD05762
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License Number State | RI
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