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NPI Code Detail

MEDICARE: RICHARD A ST. DENNIS PA

MEDICARE: RICHARD A ST. DENNIS PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant001203CT
2363A00000XPhysician AssistantPA00503RI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306879242
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD A ST. DENNIS PA
Provider Business Mailing Address
First Line : PO BOX 62939
Second Line :
City : BALTIMORE
State : MD
Zip : 21264-1551
Country : US
Telephone Number : 859-291-4800
Fax Number : 833-694-1507
Provider Business Practice Location Address
First Line : 10 WOODLAND DR
Second Line :
City : COVENTRY
State : RI
Zip : 02816-6716
Country : US
Telephone Number : 401-826-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 09/28/2023

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Directions to “ RICHARD A ST. DENNIS PA” Practice Location

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