Healthcare Provider Details

I. General information

NPI: 1588076228
Provider Name (Legal Business Name): JENNIFER ZUAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 N MAIN ST
PROVIDENCE RI
02904-5719
US

IV. Provider business mailing address

1085 N MAIN ST
PROVIDENCE RI
02904-5719
US

V. Phone/Fax

Practice location:
  • Phone: 401-415-4618
  • Fax: 401-415-4348
Mailing address:
  • Phone: 401-415-4618
  • Fax: 401-415-4348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD.16782
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: