Provider Demographics
NPI:1427055987
Name:PAOLELLA, LANDY PETER (MD)
Entity type:Individual
Prefix:
First Name:LANDY
Middle Name:PETER
Last Name:PAOLELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1130 TEN ROD RD
Mailing Address - Street 2:D201
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4161
Mailing Address - Country:US
Mailing Address - Phone:401-295-8655
Mailing Address - Fax:401-295-8335
Practice Address - Street 1:455 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2759
Practice Address - Country:US
Practice Address - Phone:401-737-1010
Practice Address - Fax:401-736-1974
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2008-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIRI63152085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7002909Medicaid
RI7002909Medicaid