Healthcare Provider Details

I. General information

NPI: 1821028705
Provider Name (Legal Business Name): BARA MOURADI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 03/29/2019
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 NumberA83434
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD12590
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: