Healthcare Provider Details

I. General information

NPI: 1780007575
Provider Name (Legal Business Name): SOUTHEASTERN NEW ENGLAND DIAGNOSTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 WARWICK AVE
WARWICK RI
02888-3655
US

IV. Provider business mailing address

1030 WARWICK AVE
WARWICK RI
02888-3655
US

V. Phone/Fax

Practice location:
  • Phone: 401-467-6210
  • Fax:
Mailing address:
  • Phone: 401-467-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN DAVID LOWNEY
Title or Position: OWNER
Credential: DO
Phone: 401-467-6210