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General NPI Number Information
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NPI Number | 1881604940
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Entity Type | Organization
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Legal Business Name | TOLL GATE RADIOLOGY INC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 12/16/2008
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Provider Practice Location Address
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Address Line | 300 TOLL GATE RD STE 101A, STE 102
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City | WARWICK
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State | RI
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Zip | 02886-4416
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Country | US
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Telephone | 401-738-3100
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Fax | 401-738-8505
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Provider Business Mailing Address
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Address Line | 215 TOLL GATE RD STE 109
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City | WARWICK
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State | RI
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Zip | 02886-4458
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Country | US
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Telephone | 401-738-3100
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Fax | 401-738-8505
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTHONY G BRUZZESE
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Credential | MD
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Telephone | 401-738-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | RAD0066
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | RAD0066
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | RAD0066
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License Number State | RI
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Taxonomy #4
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Taxonomy Code | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number | RAD0066
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License Number State | RI
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Taxonomy #5
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | RAD0066
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License Number State | RI
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Taxonomy #6
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | RAD0066
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License Number State | RI
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Taxonomy #7
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | RAD0066
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License Number State | RI
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Taxonomy #8
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | RAD0066
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License Number State | RI
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