Healthcare Provider Details

I. General information

NPI: 1811575269
Provider Name (Legal Business Name): ELIZABETH A. CONGDON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 PROVIDENCE ST
WEST WARWICK RI
02893-2508
US

IV. Provider business mailing address

25 JOHN A CUMMINGS WAY
WOONSOCKET RI
02895-3244
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-4100
  • Fax:
Mailing address:
  • Phone: 401-767-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12974651-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD21313
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: