Provider Demographics
NPI:1679534572
Name:NOONAN, THOMAS EDWARD (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:NOONAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SCHOOL ST
Mailing Address - Street 2:STE 112
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5335
Mailing Address - Country:US
Mailing Address - Phone:401-723-1210
Mailing Address - Fax:401-312-2099
Practice Address - Street 1:333 SCHOOL ST
Practice Address - Street 2:STE 112
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5335
Practice Address - Country:US
Practice Address - Phone:401-723-1210
Practice Address - Fax:401-312-2099
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD09416207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7005916Medicaid
RI7005816Medicaid
RIA2191302OtherMEDICARE PTAN
007060930Medicare PIN
A21913Medicare UPIN
007005816Medicare ID - Type Unspecified
RI7005916Medicaid