Healthcare Provider Details

I. General information

NPI: 1457309858
Provider Name (Legal Business Name): ANTHONY EMMANUEL MEGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVENUE FAIN 3
PROVIDENCE RI
02906-2853
US

IV. Provider business mailing address

164 SUMMIT AVENUE
PROVIDENCE RI
02906-2853
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-2920
  • Fax: 401-793-2859
Mailing address:
  • Phone: 401-793-4001
  • Fax: 401-793-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD08901
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: