| |
101 Dudley St Providence RI 02905-2401 | |
(401) 274-1100 | |
Not Available |
Full Name | |
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Speciality | Clinic/center |
Location | 101 Dudley St, Providence, Rhode Island |
Authorized Official Name and Position | Debra Paul (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 4012741100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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101 Dudley St Providence RI 02905-2401 Ph: (401) 274-1100 | 101 Dudley St Providence RI 02905-2401 Ph: (401) 274-1100 |
NPI Number | 1619197936 |
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Provider Enumeration Date | 04/27/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1619197936 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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