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General NPI Number Information
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NPI Number | 1023090982
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Entity Type | Individual
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Provider Name | JOHN URBAN MD
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Gender | Male
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 120 DUDLEY ST SUITE 204
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City | PROVIDENCE
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State | RI
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Zip | 02905-2436
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Country | US
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Telephone | 401-421-7486
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Fax | 401-421-4150
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Provider Business Mailing Address
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Address Line | 120 DUDLEY ST SUITE 204
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City | PROVIDENCE
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State | RI
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Zip | 02905-2436
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Country | US
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Telephone | 401-421-7486
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Fax | 401-421-4150
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD04558
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License Number State | RI
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