Healthcare Provider Details

I. General information

NPI: 1750388393
Provider Name (Legal Business Name): CHRISTINA C DIEROLF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 TURNPIKE AVE AQUIDNECK MEDICAL ASSOCIATES, INC
PORTSMOUTH RI
02871-1419
US

IV. Provider business mailing address

50 MEMORIAL BLVD AQUIDNECK MEDICAL ASSOCIATES, INC
NEWPORT RI
02840-3587
US

V. Phone/Fax

Practice location:
  • Phone: 401-683-2290
  • Fax: 401-849-8446
Mailing address:
  • Phone: 401-683-2290
  • Fax: 401-849-8446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD08861
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: