Healthcare Provider Details

I. General information

NPI: 1720523079
Provider Name (Legal Business Name): OCEAN STATE ASTHMA AND ALLERGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 CEDAR AVE SUITE 7
EAST GREENWICH RI
02818-3191
US

IV. Provider business mailing address

1637 MINERAL SPRING AVE
NORTH PROVIDENCE RI
02904-4042
US

V. Phone/Fax

Practice location:
  • Phone: 401-885-5757
  • Fax: 401-885-5796
Mailing address:
  • Phone: 401-353-1012
  • Fax: 401-353-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DINA D'ALFONSO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 401-753-0500