Healthcare Provider Details

I. General information

NPI: 1053980573
Provider Name (Legal Business Name): MERY DEEB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2021
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 EAST AVE STE 200
PAWTUCKET RI
02860-5282
US

IV. Provider business mailing address

15 LA SALLE SQ
PROVIDENCE RI
02903-1814
US

V. Phone/Fax

Practice location:
  • Phone: 401-606-1620
  • Fax: 401-721-5709
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD21385
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: