Healthcare Provider Details

I. General information

NPI: 1346217544
Provider Name (Legal Business Name): STEVEN ALAN DENOMME IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 SMITH RD
NEWPORT RI
02841-1006
US

IV. Provider business mailing address

236 WORDEN ST
PORTSMOUTH RI
02871-6217
US

V. Phone/Fax

Practice location:
  • Phone: 401-841-6104
  • Fax:
Mailing address:
  • Phone: 401-683-6150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number171010L1002X
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: