=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215924063
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RIKHI J D'SOUZA DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 481 KINGSTOWN RD
-----------------------------------------------------
City | WAKEFIELD
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02879-3626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-789-0283
-----------------------------------------------------
Fax | 401-789-0314
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 481 KINGSTOWN RD
-----------------------------------------------------
City | WAKEFIELD
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02879-3626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-789-0283
-----------------------------------------------------
Fax | 401-789-0314
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | DO00354
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------