Healthcare Provider Details

I. General information

NPI: 1225054760
Provider Name (Legal Business Name): PAULA DEYOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W RIVER ST STE 8
PROVIDENCE RI
02904
US

IV. Provider business mailing address

117 ELLENFIELD ST STE 101
PROVIDENCE RI
02905-4513
US

V. Phone/Fax

Practice location:
  • Phone: 401-606-3000
  • Fax: 401-331-8110
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD8099
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: