Healthcare Provider Details

I. General information

NPI: 1336408723
Provider Name (Legal Business Name): EMAD AWA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RANDALL SQ STE 404
PROVIDENCE RI
02904
US

IV. Provider business mailing address

172 KINSLEY ST
NASHUA NH
03060-3648
US

V. Phone/Fax

Practice location:
  • Phone: 401-861-5183
  • Fax:
Mailing address:
  • Phone: 603-882-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD16109
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18714
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number273768
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: