Healthcare Provider Details

I. General information

NPI: 1508828401
Provider Name (Legal Business Name): RICHARD K OHNMACHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 RESERVOIR AVE SUITE 210
CRANSTON RI
02920-6055
US

IV. Provider business mailing address

994 RESERVOIR AVE
CRANSTON RI
02910-5122
US

V. Phone/Fax

Practice location:
  • Phone: 401-946-1944
  • Fax: 401-946-2340
Mailing address:
  • Phone: 401-946-1944
  • Fax: 401-946-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7462
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: