Healthcare Provider Details

I. General information

NPI: 1437223195
Provider Name (Legal Business Name): LEENA DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TOLLGATE RD
WARWICK RI
02886
US

IV. Provider business mailing address

680 LOVE LANE
WARWICK RI
02818
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-8700
  • Fax:
Mailing address:
  • Phone: 401-732-8700
  • Fax: 401-732-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9991
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: