Healthcare Provider Details

I. General information

NPI: 1285644096
Provider Name (Legal Business Name): MICHAEL ECONOMOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 TOLLGATE ROAD SUITE 106
WARWICK RI
02886-4326
US

IV. Provider business mailing address

215 TOLL GATE RD SUITE 106
WARWICK RI
02886-4458
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-5600
  • Fax: 401-734-9400
Mailing address:
  • Phone: 401-732-5600
  • Fax: 401-734-9400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD9195
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: