Healthcare Provider Details

I. General information

NPI: 1801340195
Provider Name (Legal Business Name): RYAN MICHAEL LAFERTE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BREWSTER ST
PAWTUCKET RI
02860-4474
US

IV. Provider business mailing address

111 BREWSTER ST
PAWTUCKET RI
02860-4474
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA6584
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00906
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: