Healthcare Provider Details

I. General information

NPI: 1275561953
Provider Name (Legal Business Name): ROGER WILLIAMS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/22/2020
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
PROVIDENCE RI
02908-4728
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-2538
  • Fax: 401-456-2582
Mailing address:
  • Phone: 401-456-2538
  • Fax: 401-456-2582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberHOS00108
License Number StateRI

VIII. Authorized Official

Name: LYNN A DIONNE
Title or Position: A/R ANALYST
Credential:
Phone: 401-456-2677