Healthcare Provider Details

I. General information

NPI: 1609061175
Provider Name (Legal Business Name): DRS LAMPAL AND MONTGOMERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 WATERMAN ST
PROVIDENCE RI
02906-4381
US

IV. Provider business mailing address

207 WATERMAN ST
PROVIDENCE RI
02906-4381
US

V. Phone/Fax

Practice location:
  • Phone: 401-861-3155
  • Fax:
Mailing address:
  • Phone: 401-861-3155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD3488
License Number StateRI

VIII. Authorized Official

Name: HOWARD LAMPAL
Title or Position: PARTNER
Credential: MD
Phone: 401-761-3155