Healthcare Provider Details

I. General information

NPI: 1285617845
Provider Name (Legal Business Name): BRIAN F STAINKEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 CHALKSTONE AVE ROGER WILLIAMS MEDICAL CENTER - IMAGING NETWORK OF RI
PROVIDENCE RI
02908-4728
US

IV. Provider business mailing address

91 STILES RD
SALEM NH
03079-5804
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-2204
  • Fax:
Mailing address:
  • Phone: 603-893-9784
  • Fax: 603-893-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD11149
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: