Healthcare Provider Details

I. General information

NPI: 1790808020
Provider Name (Legal Business Name): JONATHAN RICHARD SCHILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DUDLEY ST
PROVIDENCE RI
02905-3236
US

IV. Provider business mailing address

2 DUDLEY ST
PROVIDENCE RI
02905-3236
US

V. Phone/Fax

Practice location:
  • Phone: 401-457-2106
  • Fax: 401-831-8951
Mailing address:
  • Phone: 401-457-2106
  • Fax: 401-831-8951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number12636
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: