Healthcare Provider Details

I. General information

NPI: 1881941540
Provider Name (Legal Business Name): ZIAD FERSAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2012
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PLAIN ST STE 401
PROVIDENCE RI
02905-3243
US

IV. Provider business mailing address

235 PLAIN ST STE 401
PROVIDENCE RI
02905-3243
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-1710
  • Fax: 401-861-2164
Mailing address:
  • Phone: 401-421-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number269506
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD16960
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: