Provider Demographics
NPI:1285080945
Name:THOMAS R. WALEK, M.D., INC.
Entity type:Organization
Organization Name:THOMAS R. WALEK, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RODRIGUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-738-7659
Mailing Address - Street 1:200 TOLL GATE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4491
Mailing Address - Country:US
Mailing Address - Phone:401-738-7659
Mailing Address - Fax:401-738-6425
Practice Address - Street 1:200 TOLL GATE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4491
Practice Address - Country:US
Practice Address - Phone:401-738-7659
Practice Address - Fax:401-738-6425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05762208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIC90652Medicare UPIN