Healthcare Provider Details

I. General information

NPI: 1265058044
Provider Name (Legal Business Name): KATHERINE ROSE MAIORISI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 EAST AVE STE 110
PAWTUCKET RI
02860-5299
US

IV. Provider business mailing address

407 EAST AVE STE 110
PAWTUCKET RI
02860-5299
US

V. Phone/Fax

Practice location:
  • Phone: 401-725-4700
  • Fax: 401-725-4740
Mailing address:
  • Phone: 401-725-4700
  • Fax: 401-725-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01242
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: