Healthcare Provider Details

I. General information

NPI: 1396726162
Provider Name (Legal Business Name): PAUL DAVID CARDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 GRANITE ST
WESTERLY RI
02891-2460
US

IV. Provider business mailing address

116 GRANITE STREET
WESTERLY RI
02891
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-5695
  • Fax: 401-596-1070
Mailing address:
  • Phone: 401-596-5695
  • Fax: 401-596-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD07536
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: