Healthcare Provider Details

I. General information

NPI: 1154307619
Provider Name (Legal Business Name): LINDA SUSAN DONEGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 METRO CENTER BOULEVARD SUITE 2000
WARWICK RI
02886
US

IV. Provider business mailing address

125 METRO CENTER BOULEVARD SUITE 2000
WARWICK RI
02886
US

V. Phone/Fax

Practice location:
  • Phone: 401-432-2520
  • Fax: 401-453-8220
Mailing address:
  • Phone: 401-432-2520
  • Fax: 401-453-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number10992
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD10992
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: