Healthcare Provider Details

I. General information

NPI: 1205112935
Provider Name (Legal Business Name): STEPHEN J D'AMATO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 QUAKER LN
WEST WARWICK RI
02893-2151
US

IV. Provider business mailing address

211 QUAKER LN
WEST WARWICK RI
02893-2151
US

V. Phone/Fax

Practice location:
  • Phone: 401-270-7077
  • Fax: 401-270-2781
Mailing address:
  • Phone: 401-270-7077
  • Fax: 401-270-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD05562
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD05562
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD05562
License Number StateRI

VIII. Authorized Official

Name: DR. STEPHEN J D'AMATO
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 401-270-7077