Healthcare Provider Details

I. General information

NPI: 1609610518
Provider Name (Legal Business Name): MOLLY RUGGLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DUDLEY ST
PROVIDENCE RI
02905-2499
US

IV. Provider business mailing address

144 DELAINE ST APT 123
PROVIDENCE RI
02909-2780
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-1100
  • Fax:
Mailing address:
  • Phone: 317-447-4618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberCLP07071
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: