Healthcare Provider Details

I. General information

NPI: 1508990557
Provider Name (Legal Business Name): MARCEL ABEL BAVOUX D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 HARTFORD AVE STE 3B
JOHNSTON RI
02919-7137
US

IV. Provider business mailing address

1239 HARTFORD AVE STE 3B
JOHNSTON RI
02919-7137
US

V. Phone/Fax

Practice location:
  • Phone: 401-209-1760
  • Fax: 401-209-1761
Mailing address:
  • Phone: 401-209-1760
  • Fax: 401-209-1761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00414
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: