Healthcare Provider Details

I. General information

NPI: 1891719563
Provider Name (Legal Business Name): ALLIANCE ENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N MAIN ST SUITE 1
PROVIDENCE RI
02904-5700
US

IV. Provider business mailing address

845 N MAIN ST SUITE 1
PROVIDENCE RI
02904-5700
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-9690
  • Fax: 401-331-9609
Mailing address:
  • Phone: 401-331-9690
  • Fax: 401-331-9609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. FREDERICK A. GODLEY
Title or Position: PRESIDENT
Credential: MD
Phone: 401-331-9690