Healthcare Provider Details

I. General information

NPI: 1548919400
Provider Name (Legal Business Name): JOAN MANUEL RODRIGUEZ TAVERAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

801 MASSACHUSETTS AVE FL 6
BOSTON MA
02118-2605
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-8689
  • Fax: 401-444-4652
Mailing address:
  • Phone: 617-414-5951
  • Fax: 617-414-9251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberLP06520
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: