Healthcare Provider Details

I. General information

NPI: 1316398571
Provider Name (Legal Business Name): DALAL HASSAN ELSORI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

BLOCK 3 STREET 307 HOUSE 82 AL MASAYEL
KUWAIT KUWAIT
00000
KW

V. Phone/Fax

Practice location:
  • Phone: 401-444-6195
  • Fax: 401-444-6378
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.027791
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD16626
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: