Healthcare Provider Details

I. General information

NPI: 1073539227
Provider Name (Legal Business Name): MEDICINE AND LONG TERM CARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BUDLONG RD
CRANSTON RI
02920-6337
US

IV. Provider business mailing address

333 BUDLONG RD
CRANSTON RI
02920-6337
US

V. Phone/Fax

Practice location:
  • Phone: 401-943-4530
  • Fax:
Mailing address:
  • Phone: 401-943-4530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00420
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00144
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number00220
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6040
License Number StateRI
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12044
License Number StateRI
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD03601
License Number StateRI
# 7
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number12101
License Number StateRI

VIII. Authorized Official

Name: HAO YUAN HUANG
Title or Position: M.D./OWNER
Credential: M.D.
Phone: 401-943-4530