Healthcare Provider Details

I. General information

NPI: 1023193281
Provider Name (Legal Business Name): SUSAN M. STUART D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WELLS ST
WESTERLY RI
02891-2927
US

IV. Provider business mailing address

46 WELLS ST
WESTERLY RI
02891-2924
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-3229
  • Fax: 401-596-0850
Mailing address:
  • Phone: 401-596-0174
  • Fax: 401-596-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRI0486
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: