Healthcare Provider Details

I. General information

NPI: 1295987543
Provider Name (Legal Business Name): VICKY CHENG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WAMPANOAG TRL STE 202B
RIVERSIDE RI
02915-2234
US

IV. Provider business mailing address

110 ELM ST
PROVIDENCE RI
02903-4626
US

V. Phone/Fax

Practice location:
  • Phone: 401-649-4090
  • Fax: 401-649-4091
Mailing address:
  • Phone: 877-771-7401
  • Fax: 401-784-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD13623
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: