Healthcare Provider Details

I. General information

NPI: 1629481825
Provider Name (Legal Business Name): ZACHARY JOHN QUAY-DE LA VALLEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W RIVER ST STE 2A
PROVIDENCE RI
02904-2615
US

IV. Provider business mailing address

148 W RIVER ST STE 2A
PROVIDENCE RI
02904-2615
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5000
  • Fax: 401-727-1979
Mailing address:
  • Phone: 401-616-1719
  • Fax: 401-727-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD16762
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: