Healthcare Provider Details

I. General information

NPI: 1588088850
Provider Name (Legal Business Name): THE MIRIAM HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE FAIN BLDG
PROVIDENCE RI
02906-2853
US

IV. Provider business mailing address

15 LA SALLE SQ
PROVIDENCE RI
02903-1814
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-5001
  • Fax: 401-793-5191
Mailing address:
  • Phone: 401-444-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER K MARKELL
Title or Position: E VP & CFO
Credential:
Phone: 401-444-7914