Healthcare Provider Details

I. General information

NPI: 1518018811
Provider Name (Legal Business Name): P WILFREDO CANCHIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 ATWOOD AVE SUITE 100
JOHNSTON RI
02919-3289
US

IV. Provider business mailing address

2 FERNCREST CT
LINCOLN RI
02865-4732
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-9400
  • Fax:
Mailing address:
  • Phone: 401-727-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD09384
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: