Healthcare Provider Details

I. General information

NPI: 1477977064
Provider Name (Legal Business Name): ROGER WILLIAMS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 CHALKSTONE AVE
PROVIDENCE RI
02908-4728
US

IV. Provider business mailing address

825 CHALKSTONE AVE N. CAMPUS BUSINESS OFFICE, ATTN: R. SOARES
PROVIDENCE RI
02908-4728
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-2000
  • Fax:
Mailing address:
  • Phone: 401-456-2525
  • Fax: 401-456-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberHOS00108
License Number StateRI

VIII. Authorized Official

Name: KENNETH BELCHER
Title or Position: PRESIDENT, CEO
Credential:
Phone: 401-456-2525