Healthcare Provider Details

I. General information

NPI: 1477572816
Provider Name (Legal Business Name): MARINA KUPERMAN-BEADE M.D., F.A.A.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 PRESIDENT AVE STE 306
FALL RIVER MA
02720-5923
US

IV. Provider business mailing address

1 RANDALL SQUARE SUITE 306
PROVIDENCE RI
02904-2709
US

V. Phone/Fax

Practice location:
  • Phone: 401-751-7546
  • Fax: 401-751-6888
Mailing address:
  • Phone: 401-751-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD10753
License Number StateRI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP00241153
Identifier TypeOTHER
Identifier StateRI
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier9023992
Identifier TypeMEDICAID
Identifier StateRI
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: