Healthcare Provider Details

I. General information

NPI: 1548352990
Provider Name (Legal Business Name): EDMUND T DOSREMEDIOS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PLAIN STREET SUITE 201
PROVIDENCE RI
02905-3240
US

IV. Provider business mailing address

DEPT 3010, PO BOX 986524
BOSTON MA
02298-6524
US

V. Phone/Fax

Practice location:
  • Phone: 401-861-8830
  • Fax: 401-351-2378
Mailing address:
  • Phone: 833-924-5546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberDPM00296
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: