Healthcare Provider Details

I. General information

NPI: 1720139405
Provider Name (Legal Business Name): SUSAN W ANDREWS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 DILLABUR AVE
NORTH KINGSTOWN RI
02852
US

IV. Provider business mailing address

235 ROLLINGWOOD DR
NORTH KINGSTOWN RI
02852-4648
US

V. Phone/Fax

Practice location:
  • Phone: 401-268-2691
  • Fax:
Mailing address:
  • Phone: 401-268-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number158774
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: