Healthcare Provider Details

I. General information

NPI: 1659824696
Provider Name (Legal Business Name): REEMA QURESHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BREWSTER ST
PAWTUCKET RI
02860-4474
US

IV. Provider business mailing address

164 SUMMIT AVE
PROVIDENCE RI
02906-2853
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-2258
  • Fax: 401-729-3343
Mailing address:
  • Phone: 401-793-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP03796
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD17731
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD17729
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: