Healthcare Provider Details

I. General information

NPI: 1376531269
Provider Name (Legal Business Name): RICHARD A HAAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
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: 401-921-9212
Mailing address:
  • Phone: 401-432-2520
  • Fax: 401-921-9212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number6614
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD06614
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number06614
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD06614
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: