Healthcare Provider Details

I. General information

NPI: 1548198062
Provider Name (Legal Business Name): IRTEBAAT FATIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CASS AVENUE LANDMARK MEDICAL CENTER ATTN GME OFFICE
WOONSOCKET RI
02895
US

IV. Provider business mailing address

115 CASS AVENUE LANDMARK MEDICAL CENTER ATTN GME OFFICE
WOONSOCKET RI
02895
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-2000
  • Fax: 401-767-1651
Mailing address:
  • Phone: 401-769-2000
  • Fax: 401-767-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: