Healthcare Provider Details

I. General information

NPI: 1770591190
Provider Name (Legal Business Name): DWIGHT J ROUSE MD, MSPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PLAIN ST
PROVIDENCE RI
02903-4828
US

IV. Provider business mailing address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-1122
  • Fax: 401-453-7622
Mailing address:
  • Phone: 401-274-1122
  • Fax: 401-453-7622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD13078
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: