Healthcare Provider Details

I. General information

NPI: 1265016042
Provider Name (Legal Business Name): JAMES HENRY NOON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2021
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

125 METRO CENTER BLVD STE 2000
WARWICK RI
02886-1785
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5174
  • Fax:
Mailing address:
  • Phone: 401-432-2500
  • Fax: 401-889-3619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01342
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: