Healthcare Provider Details

I. General information

NPI: 1285664524
Provider Name (Legal Business Name): PRIMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2178 MENDON RD SUITE 100
CUMBERLAND RI
02864
US

IV. Provider business mailing address

2178 MENDON RD SUITE 100
CUMBERLAND RI
02864
US

V. Phone/Fax

Practice location:
  • Phone: 401-333-5201
  • Fax: 401-333-5215
Mailing address:
  • Phone: 401-333-5201
  • Fax: 401-333-5215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CAROL O'SHEA
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 401-333-5201