Healthcare Provider Details

I. General information

NPI: 1801161484
Provider Name (Legal Business Name): SMGRI, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WEYBOSSET ST
PROVIDENCE RI
02903-2818
US

IV. Provider business mailing address

500 BOYLSTON ST
BOSTON MA
02116-3740
US

V. Phone/Fax

Practice location:
  • Phone: 617-419-4700
  • Fax:
Mailing address:
  • Phone: 617-419-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CALLUM
Title or Position: CEO
Credential: MD
Phone: 617-419-4702