Healthcare Provider Details

I. General information

NPI: 1992600134
Provider Name (Legal Business Name): SAMUEL WEBSTER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 MINERAL SPRING AVE
NORTH PROVIDENCE RI
02904-3864
US

IV. Provider business mailing address

15 BELMONT AVE
EAST PROVIDENCE RI
02914-3900
US

V. Phone/Fax

Practice location:
  • Phone: 401-351-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: