Healthcare Provider Details

I. General information

NPI: 1518301480
Provider Name (Legal Business Name): DANIEL REGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 ELMWOOD AVE
WARWICK RI
02888-2404
US

IV. Provider business mailing address

2020 ELMWOOD AVE
WARWICK RI
02888-2404
US

V. Phone/Fax

Practice location:
  • Phone: 401-781-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCDP00511
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: