Healthcare Provider Details

I. General information

NPI: 1114193075
Provider Name (Legal Business Name): HOPE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 N MAIN ST
PROVIDENCE RI
02904-5704
US

IV. Provider business mailing address

770 N MAIN ST
PROVIDENCE RI
02904-5704
US

V. Phone/Fax

Practice location:
  • Phone: 401-455-3574
  • Fax: 401-455-3624
Mailing address:
  • Phone: 401-455-3574
  • Fax: 401-455-3624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WADID S AZER
Title or Position: PRESIDENT
Credential: MD
Phone: 401-455-3574