Healthcare Provider Details

I. General information

NPI: 1609110188
Provider Name (Legal Business Name): RI PLASTIC SURGERY OPERATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BRIDGE ST
PROVIDENCE RI
02903-4362
US

IV. Provider business mailing address

10 BRIDGE STREET
PROVIDENCE RI
02903
US

V. Phone/Fax

Practice location:
  • Phone: 401-453-0120
  • Fax: 401-453-0198
Mailing address:
  • Phone: 401-453-0120
  • Fax: 401-453-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0000000000
License Number StateRI

VIII. Authorized Official

Name: MS. KATHLEEN GLASSIE
Title or Position: MANAGER
Credential:
Phone: 401-855-0605