Healthcare Provider Details

I. General information

NPI: 1427129725
Provider Name (Legal Business Name): MARSHALL EDWARD KADIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WINNISIMET DR
TIVERTON RI
02878-4733
US

IV. Provider business mailing address

201 WINNISIMET DR
TIVERTON RI
02878-4733
US

V. Phone/Fax

Practice location:
  • Phone: 401-624-2715
  • Fax:
Mailing address:
  • Phone: 401-624-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberMD11034
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number53780
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: