Healthcare Provider Details

I. General information

NPI: 1114912193
Provider Name (Legal Business Name): ANDREW J LEMOI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 MAIN ST STE 21
EAST GREENWICH RI
02818-3161
US

IV. Provider business mailing address

1050 MAIN ST STE 21
EAST GREENWICH RI
02818-3161
US

V. Phone/Fax

Practice location:
  • Phone: 401-886-1132
  • Fax: 401-885-6091
Mailing address:
  • Phone: 401-886-1132
  • Fax: 401-885-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberRIDPM301
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: