Doctor Name: | DR. THADDEUS WILSON HERLICZEK |
NPI Number: | 1053457721 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 214342 |
Business Practice Address: | 20 Catamore Blvd East Providence, RI - 029141204 |
Business Phone Number: | 4014277828 |
Business Fax Number: | 4014322457 |
Mailing Address: | 20 Catamore Blvd, EAST PROVIDENCE |
State: | RI |
Postal Code: | 029141204 |
Phone Number: | 4014277828 |
Fax Number: | 4014322457 |
NPI Enumeration Date: | 01/30/2007 |
NPI Last Update Date: | 08/05/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2085R0202X |
License Number: | 214342 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Radiology |
Taxonomy Specialization: | Diagnostic Radiology |
Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |