| Name: | Sebastian Trombatore, M.D., LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 20 Dec 2005 (19 years ago) |
| Date of Dissolution: | 22 Apr 2013 (12 years ago) |
| Date of Status Change: | 22 Apr 2013 (12 years ago) |
| Identification Number: | 000152451 |
| ZIP code: | 02886 |
| County: | Kent County |
| Principal Address: | 300 TOLLGATE ROAD, WARWICK, RI, 02886, USA |
| Purpose: | PHYSICIANS OFFICE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568634566 | 2008-03-31 | 2008-04-01 | 300 TOLL GATE RD, SUITE 305, WARWICK, RI, 028864416, US | 300 TOLL GATE RD, SUITE 305, WARWICK, RI, 028864416, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 401-738-6611 |
| Fax | 4017380013 |
Authorized person
| Name | DR. SEBASTIAN TROMBATORE |
| Role | OWNER |
| Phone | 4017386611 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | 6797 |
| State | RI |
| Is Primary | Yes |
| Taxonomy Code | 2086S0129X - Vascular Surgery Physician |
| License Number | 6797 |
| State | RI |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9004732 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| SEBASTIAN TROMBATORE, MD | Agent | 300 TOLLGATE ROAD, WARWICK, RI, 02886, USA |
| Number | Name | File Date |
|---|---|---|
| 201315452700 | Revocation Certificate For Failure to File the Annual Report for the Year | 2013-04-22 |
| 201308451730 | Revocation Notice For Failure to File An Annual Report | 2013-01-09 |
| 201183983270 | Annual Report | 2011-10-11 |
| 201071467190 | Annual Report | 2010-11-01 |
| 200955646690 | Statement of Change of Registered/Resident Agent | 2009-12-24 |
| 200951878950 | Annual Report | 2009-09-30 |
| 200837482680 | Annual Report | 2008-11-03 |
| 200703286570 | Annual Report | 2007-10-29 |
| 200701689120 | Statement of Change of Registered/Resident Agent | 2007-10-29 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
