Healthcare Provider Details

I. General information

NPI: 1255357737
Provider Name (Legal Business Name): J DOUGLAS NISBET II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN DOUGLAS NISBET II MD

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/18/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 TOLL GATE RD STE 201
WARWICK RI
02886-4326
US

IV. Provider business mailing address

445 TOLL GATE RD PRC AND CREDENTIALING
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-8803
  • Fax: 401-738-7658
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number6757
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: