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POLLY E. LEONARD, D.O. LTD.

POLLY E. LEONARD, D.O. LTD.

Company Details

Name:	POLLY E. LEONARD, D.O. LTD.
Jurisdiction:	Rhode Island
Entity type:	Domestic Profit Corporation
Status:	Revoked Entity
Date of Organization in Rhode Island:	07 May 1999 (26 years ago)
Date of Dissolution:	29 Jul 2021 (3 years ago)
Date of Status Change:	29 Jul 2021 (3 years ago)
Identification Number:	000106349
ZIP code:	02886
County:	Kent County
Principal Address:	390 TOLLGATE ROAD SUITE 203, WARWICK, RI, 02886, USA
Purpose:	TO PRACTICE MEDICINE
NAICS:	621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1972746550

2009-04-13

2009-04-13

390 TOLL GATE RD, SUITE 203, WARWICK, RI, 028864326, US

390 TOLL GATE RD, SUITE 203, WARWICK, RI, 028864326, US

Contacts

Phone	+1 401-732-2031
Fax	4017322035

Authorized person

Name	DR. POLLY LEONARD
Role	OWNER/DOCTOR
Phone	4017322031

Taxonomy

Taxonomy Code	207Q00000X - Family Medicine Physician
License Number	DO496
State	RI
Is Primary	Yes

Other Provider Identifiers

Issuer	MEDICAID
Number	9002762
State	RI

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

POLLY E. LEONARD, D.O., LTD. 401(K) PLAN

2022

050505196

2023-10-16

POLLY E. LEONARD, D.O., LTD.

3

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	4017322031
Plan sponsor’s address	390 TOLL GATE ROAD, SUITE 203, WARWICK, RI, 02886

POLLY E. LEONARD, D.O., LTD. 401(K) PLAN

2021

050505196

2022-10-15

POLLY E. LEONARD, D.O., LTD.

3

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	4017322031
Plan sponsor’s address	390 TOLL GATE ROAD, SUITE 203, WARWICK, RI, 02886

POLLY E. LEONARD, D.O., LTD. 401(K) PLAN

2020

050505196

2021-10-14

POLLY E. LEONARD, D.O., LTD.

3

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	4017322031
Plan sponsor’s address	390 TOLL GATE ROAD, SUITE 203, WARWICK, RI, 02886

POLLY E. LEONARD, D.O., LTD. 401(K) PLAN

2019

050505196

2020-10-08

POLLY E. LEONARD, D.O., LTD.

3

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	4017322031
Plan sponsor’s address	390 TOLL GATE ROAD, SUITE 203, WARWICK, RI, 02886

POLLY E. LEONARD, D.O., LTD. 401(K) PLAN

2018

050505196

2019-09-27

POLLY E. LEONARD, D.O., LTD.

3

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	4017322031
Plan sponsor’s address	390 TOLL GATE ROAD, SUITE 203, WARWICK, RI, 02886

POLLY E. LEONARD, D.O., LTD. 401(K) PLAN

2017

050505196

2018-10-10

POLLY E. LEONARD, D.O., LTD.

3

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	4017322031
Plan sponsor’s address	390 TOLL GATE ROAD, SUITE 203, WARWICK, RI, 02886

POLLY E. LEONARD, D.O., LTD. 401(K) PLAN

2016

050505196

2017-10-12

POLLY E. LEONARD, D.O., LTD.

3

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	4017322031
Plan sponsor’s address	390 TOLL GATE ROAD, SUITE 203, WARWICK, RI, 02886

Agent

Name	Role	Address
POLLY E. LEONARD, D.O.	Agent	390 TOLL GATE ROAD SUITE 203, WARWICK, RI, 02886, USA

PRESIDENT

Name	Role	Address
POLLY E. LEONARD DO	PRESIDENT	390 TOLLGATE ROAD, SUITE 203 WARWICK, RI 02886 USA

Filings

Number	Name	File Date
202199644890	Revocation Certificate For Failure to File the Annual Report for the Year	2021-07-29
202196792170	Revocation Notice For Failure to File An Annual Report	2021-05-19
202039919960	Annual Report	2020-05-11
201994459890	Annual Report	2019-05-24
201878190930	Annual Report	2018-09-24
201875477980	Revocation Notice For Failure to File An Annual Report	2018-08-24
201731336130	Annual Report	2017-02-02
201692611680	Annual Report	2016-02-17
201555567770	Annual Report	2015-02-23
201435752290	Annual Report	2014-02-18
201313996350	Annual Report	2013-03-15
201290996350	Annual Report	2012-03-15
201176972670	Annual Report	2011-03-28
201060179970	Annual Report	2010-03-12
200943828550	Annual Report	2009-03-12
200834782170	Annual Report	2008-09-05
200812963900	Revocation Notice For Failure to File An Annual Report	2008-08-04
202033332530	Statement of Change of Registered/Resident Agent Office	2007-07-17
202033332710	Revocation Notice For Failure to File An Annual Report	2006-07-25
202033332350	Annual Reports - Prior to 2006	2005-03-17

Date of last update: 08 Oct 2024

Sources: Rhode Island Department of State