Healthcare Provider Details

I. General information

NPI: 1720081441
Provider Name (Legal Business Name): KATHLEEN M STAUDINGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 HAMLET AVE
WOONSOCKET RI
02895-4423
US

IV. Provider business mailing address

5 PADDOCK DR
LINCOLN RI
02865-4947
US

V. Phone/Fax

Practice location:
  • Phone: 401-762-0020
  • Fax: 401-762-1819
Mailing address:
  • Phone: 401-728-9737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD06474
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD06474
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberMD06474
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: