Healthcare Provider Details

I. General information

NPI: 1790113967
Provider Name (Legal Business Name): DAVID STOWIK P.A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CATAMORE BLVD
EAST PROVIDENCE RI
02914-1204
US

IV. Provider business mailing address

20 CATAMORE BLVD
EAST PROVIDENCE RI
02914-1204
US

V. Phone/Fax

Practice location:
  • Phone: 401-432-2500
  • Fax: 401-453-8220
Mailing address:
  • Phone: 401-432-2500
  • Fax: 401-453-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00725
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00725
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: