Healthcare Provider Details

I. General information

NPI: 1518067883
Provider Name (Legal Business Name): TODD EVAN HANDEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 MAIN ST
PAWTUCKET RI
02860-4807
US

IV. Provider business mailing address

1145 MAIN ST
PAWTUCKET RI
02860-4807
US

V. Phone/Fax

Practice location:
  • Phone: 401-305-5280
  • Fax: 401-305-5285
Mailing address:
  • Phone: 401-305-5280
  • Fax: 401-305-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD10599
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: