Healthcare Provider Details

I. General information

NPI: 1982630927
Provider Name (Legal Business Name): EDWARD M DONNELLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JAMES P MURPHY IND HWY STE 120
WEST WARWICK RI
02893-2366
US

IV. Provider business mailing address

15 LA SALLE SQ
PROVIDENCE RI
02903-1814
US

V. Phone/Fax

Practice location:
  • Phone: 401-606-4600
  • Fax: 401-444-3205
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD10851
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberMD10851
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: