Healthcare Provider Details

I. General information

NPI: 1396996534
Provider Name (Legal Business Name): TOTALHEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TOLL GATE RD STE LL1
WARWICK RI
02886-4448
US

IV. Provider business mailing address

75 NEWMAN AVE
RUMFORD RI
02916-1945
US

V. Phone/Fax

Practice location:
  • Phone: 401-244-5225
  • Fax:
Mailing address:
  • Phone: 401-453-0666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD11918
License Number StateRI

VIII. Authorized Official

Name: OKOSUN EDORO
Title or Position: OWNER
Credential: MD
Phone: 401-244-5225