Healthcare Provider Details

I. General information

NPI: 1932278322
Provider Name (Legal Business Name): HEATHER M HURLBURT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 TOLL GATE RD SUITE 205
WARWICK RI
02886
US

IV. Provider business mailing address

390 TOLL GATE RD SUITE 205
WARWICK RI
02886
US

V. Phone/Fax

Practice location:
  • Phone: 401-921-6263
  • Fax: 401-921-6569
Mailing address:
  • Phone: 401-921-6263
  • Fax: 401-921-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number220452
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number12258
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD12258
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: