Healthcare Provider Details

I. General information

NPI: 1235202201
Provider Name (Legal Business Name): RHODE ISLAND DERMATOLOGY OBS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WAKE ROBIN RD UNIT 5
LINCOLN RI
02865-4208
US

IV. Provider business mailing address

3 WAKE ROBIN RD UNIT 5
LINCOLN RI
02865-4208
US

V. Phone/Fax

Practice location:
  • Phone: 401-475-9140
  • Fax: 401-475-9143
Mailing address:
  • Phone: 401-475-9140
  • Fax: 401-475-9143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateRI

VIII. Authorized Official

Name: MS. SUSAN SCHUMACHER
Title or Position: BILLING MANAGER
Credential:
Phone: 401-475-9140