Healthcare Provider Details

I. General information

NPI: 1619106465
Provider Name (Legal Business Name): DONALD JAMES MCALLISTER SFIDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 RESOLUTE RD
NEWPORT RI
02840-1015
US

IV. Provider business mailing address

W-36 ELLOIT RD
NEWPORT RI
02841
US

V. Phone/Fax

Practice location:
  • Phone: 401-841-6936
  • Fax: 401-841-7160
Mailing address:
  • Phone: 401-841-6936
  • Fax: 401-841-7160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: