Healthcare Provider Details

I. General information

NPI: 1114912441
Provider Name (Legal Business Name): JANE M DENNISON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 MAPLE AVE
BARRINGTON RI
02806-3406
US

IV. Provider business mailing address

234 MAPLE AVE
BARRINGTON RI
02806-3406
US

V. Phone/Fax

Practice location:
  • Phone: 401-247-1644
  • Fax: 401-247-4961
Mailing address:
  • Phone: 401-247-1644
  • Fax: 401-247-4961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6326
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: