Healthcare Provider Details

I. General information

NPI: 1114247210
Provider Name (Legal Business Name): WILLIAM CHIPPENDALE MASTERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 ATWOOD AVE
JOHNSTON RI
02919-3223
US

IV. Provider business mailing address

1516 ATWOOD AVE
JOHNSTON RI
02919-3223
US

V. Phone/Fax

Practice location:
  • Phone: 401-553-1000
  • Fax: 401-553-1143
Mailing address:
  • Phone: 401-553-1000
  • Fax: 401-553-1143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: