Healthcare Provider Details

I. General information

NPI: 1871049429
Provider Name (Legal Business Name): ORTHOPEDICS RHODE ISLAND, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CENTERVILLE ROAD
WARWICK RI
02886
US

IV. Provider business mailing address

120 CENTERVILLE ROAD
WARWICK RI
02886
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-3730
  • Fax: 401-738-3777
Mailing address:
  • Phone: 401-738-3730
  • Fax: 401-738-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY ELLEN ASHE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 716-913-5012