Healthcare Provider Details

I. General information

NPI: 1861689846
Provider Name (Legal Business Name): HOSPITAL INTERNISTS OF WESTERLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WELLS ST
WESTERLY RI
02891-2922
US

IV. Provider business mailing address

25 WELLS ST
WESTERLY RI
02891-2922
US

V. Phone/Fax

Practice location:
  • Phone: 860-271-4364
  • Fax: 860-444-5114
Mailing address:
  • Phone: 860-271-4364
  • Fax: 860-444-5114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH W DONOVAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 860-271-4364