Healthcare Provider Details

I. General information

NPI: 1649056508
Provider Name (Legal Business Name): VMD PRIMARY PROVIDERS OF RHODE ISLAND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PUTNAM PIKE
SMITHFIELD RI
02917-2408
US

IV. Provider business mailing address

PO BOX 30034
BELFAST ME
04915-2052
US

V. Phone/Fax

Practice location:
  • Phone: 401-757-6160
  • Fax: 401-349-0840
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FONDA SHANKS
Title or Position: DIRECTOR REV CYCLE
Credential:
Phone: 844-969-0686