Healthcare Provider Details

I. General information

NPI: 1588940712
Provider Name (Legal Business Name): ROGER WILLIAMS MEDICAL ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 06/22/2012
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 N. CAMPUS BUSINESS OFFICE/ ATTN. R SOARES
PROVIDENCE RI
02908-4728
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-2000
  • Fax:
Mailing address:
  • Phone: 401-456-2525
  • Fax: 401-456-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberHOS00108
License Number StateRI

VIII. Authorized Official

Name: KENNETH BELCHER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 401-456-2025