Healthcare Provider Details

I. General information

NPI: 1225477896
Provider Name (Legal Business Name): SHENJUN ZHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE
PROVIDENCE RI
02906-2894
US

IV. Provider business mailing address

164 SUMMIT AVE
PROVIDENCE RI
02906-2894
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-2500
  • Fax: 401-793-4047
Mailing address:
  • Phone: 401-793-2500
  • Fax: 401-793-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1021800
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD15495
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: