Healthcare Provider Details

I. General information

NPI: 1174522304
Provider Name (Legal Business Name): WEST BAY SURGICAL ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 TOLL GATE RD STE.200
WARWICK RI
02886-4326
US

IV. Provider business mailing address

390 TOLL GATE RD STE.200
WARWICK RI
02886-4326
US

V. Phone/Fax

Practice location:
  • Phone: 401-739-8010
  • Fax: 401-739-6087
Mailing address:
  • Phone: 401-739-8010
  • Fax: 401-739-6087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateRI

VIII. Authorized Official

Name: DR. CANDACE L. DYER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 401-739-8010