Healthcare Provider Details

I. General information

NPI: 1962455626
Provider Name (Legal Business Name): RONALD RAYMOND TRUDEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 VETERANS MEMORIAL PKWY # 15B
EAST PROVIDENCE RI
02914-5300
US

IV. Provider business mailing address

259 CENTRAL AVE
JOHNSTON RI
02919-4941
US

V. Phone/Fax

Practice location:
  • Phone: 401-434-3350
  • Fax:
Mailing address:
  • Phone: 801-891-9313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD21580
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number4866189-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4866189-1205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number48661891205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: