Healthcare Provider Details

I. General information

NPI: 1215992870
Provider Name (Legal Business Name): DAVID M BOURASSA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLINTON STREET
WOONSOCKET RI
02895
US

IV. Provider business mailing address

171 SERVICE AVENUE
WARWICK RI
02886
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-4100
  • Fax: 401-235-6894
Mailing address:
  • Phone: 401-767-4100
  • Fax: 401-235-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD09354
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: