Healthcare Provider Details

I. General information

NPI: 1285690313
Provider Name (Legal Business Name): LORETTA M. MARION DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 PRAIRIE AVE
PROVIDENCE RI
02905-1928
US

IV. Provider business mailing address

375 ALLENS AVE
PROVIDENCE RI
02905-5010
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-0570
  • Fax: 401-444-0427
Mailing address:
  • Phone: 401-780-2511
  • Fax: 401-780-2565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS007739L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO37583
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO01075
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: