Healthcare Provider Details

I. General information

NPI: 1639175482
Provider Name (Legal Business Name): HEIDI J DORRIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 KINGSTOWN RD
WAKEFIELD RI
02879-3626
US

IV. Provider business mailing address

106 NATE WHIPPLE HWY STE 101
CUMBERLAND RI
02864-1403
US

V. Phone/Fax

Practice location:
  • Phone: 401-789-0283
  • Fax: 401-789-0314
Mailing address:
  • Phone: 401-658-2020
  • Fax: 401-658-3612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD10153
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: