Healthcare Provider Details

I. General information

NPI: 1790032746
Provider Name (Legal Business Name): SUSAN M. STUART, DO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 WELLS ST
WESTERLY RI
02891-2924
US

IV. Provider business mailing address

46 WELLS ST
WESTERLY RI
02891-2924
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-0174
  • Fax: 401-596-2266
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 Number00486
License Number StateRI

VIII. Authorized Official

Name: DR. SUSAN M STUART
Title or Position: PRESIDENT
Credential: DO
Phone: 401-596-0174