Healthcare Provider Details

I. General information

NPI: 1396433348
Provider Name (Legal Business Name): D REGAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TOLL GATE RD STE LL5
WARWICK RI
02886-4448
US

IV. Provider business mailing address

300 TOLL GATE RD STE LL5
WARWICK RI
02886-4448
US

V. Phone/Fax

Practice location:
  • Phone: 401-431-9024
  • Fax: 401-431-9027
Mailing address:
  • Phone: 401-431-9024
  • Fax: 401-431-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JIM CROSS
Title or Position: OFFICE ADMIN
Credential:
Phone: 401-320-8289