Healthcare Provider Details

I. General information

NPI: 1295028611
Provider Name (Legal Business Name): MATTHEW OLIVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DUDLEY ST PROGRAM IN WOMEN'S ONCOLOGY
PROVIDENCE RI
02905-2401
US

IV. Provider business mailing address

101 DUDLEY ST PROGRAM IN WOMEN'S ONCOLOGY
PROVIDENCE RI
02905-2401
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-1122
  • Fax:
Mailing address:
  • Phone: 401-274-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD14914
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number278102
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number278102
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD14914
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: