Healthcare Provider Details

I. General information

NPI: 1053708560
Provider Name (Legal Business Name): ALEXANDER STURGIS MACOMBER FYE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 BELLEVUE AVE STE 244
NEWPORT RI
02840-3516
US

IV. Provider business mailing address

270 BELLEVUE AVE STE 244
NEWPORT RI
02840-3516
US

V. Phone/Fax

Practice location:
  • Phone: 401-341-9257
  • Fax: 855-293-1908
Mailing address:
  • Phone: 401-341-9257
  • Fax: 855-293-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30265
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD19615
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: