Basic Information
| Provider Information | |||||||||
| NPI: | 1477540185 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLERICK | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 TOLL GATE RD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028862759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017377000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 455 TOLL GATE RD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028862759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017377000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 08/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD07313 | RI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 050483739 | 01 | RI | HEALTH NET / TRI CARE | OTHER | 200893 | 01 | RI | BLUE CHIP | OTHER | 302210 | 01 | RI | TUFTS HEALTH PLAN | OTHER | 709003943 | 01 | RI | MEDICARE GROUP | OTHER | 7057225 | 05 | RI | MEDICAID | 050483739 | 01 | RI | GREAT WEST HEALTH CARE | OTHER | 2239332 | 01 | RI | AETNA | OTHER | 29311-0 | 01 | RI | BCBS OF RI | OTHER | 3888906 | 01 | RI | CIGNA | OTHER | 65228 | 01 | RI | HAVARD HEALTH PLAN | OTHER | 12277884 | 01 | RI | MULTI PLAN | OTHER | 04-00378 | 01 | RI | UNITED HEALTH CARE | OTHER | 2046289 | 01 | RI | HEALTH CARE VALUE MGT | OTHER |