Healthcare Provider Details

I. General information

NPI: 1265952576
Provider Name (Legal Business Name): ALI ALKHAYAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BREWSTER STREET
PAWTUCKET RI
02860
US

IV. Provider business mailing address

111 BREWSTER ST
PAWTUCKET RI
02860-4474
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-2258
  • Fax: 401-729-2202
Mailing address:
  • Phone: 401-729-2258
  • Fax: 401-729-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP04131
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: