Healthcare Provider Details

I. General information

NPI: 1467982082
Provider Name (Legal Business Name): DARDAN BEQIRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY STREET
PROVIDENCE RI
02903
US

IV. Provider business mailing address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4188
  • Fax: 401-444-4863
Mailing address:
  • Phone: 401-444-4188
  • Fax: 401-444-4863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberLP04089
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD19385
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: