Healthcare Provider Details

I. General information

NPI: 1467501882
Provider Name (Legal Business Name): DIANE E MINASIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BULLOCKS POINT AVE
RIVERSIDE RI
02915-5351
US

IV. Provider business mailing address

100 BULLOCKS POINT AVE
RIVERSIDE RI
02915-5351
US

V. Phone/Fax

Practice location:
  • Phone: 401-437-1008
  • Fax: 401-433-3042
Mailing address:
  • Phone: 401-437-1008
  • Fax: 401-433-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD08367
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: