Healthcare Provider Details

I. General information

NPI: 1104544949
Provider Name (Legal Business Name): VA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

IV. Provider business mailing address

409 HOPE ST
PROVIDENCE RI
02906-1634
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7100
  • Fax:
Mailing address:
  • Phone: 401-378-4801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. ZHEN-MING MATTHEW FENG
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 401-378-4801