Healthcare Provider Details

I. General information

NPI: 1811072986
Provider Name (Legal Business Name): MICHELE A MATHIEU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEEHAN LN
CUMBERLAND RI
02864-1413
US

IV. Provider business mailing address

2 MEEHAN LN
CUMBERLAND RI
02864-1413
US

V. Phone/Fax

Practice location:
  • Phone: 401-658-2525
  • Fax: 401-658-3031
Mailing address:
  • Phone: 401-658-2525
  • Fax: 401-658-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD11209
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: