=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275633547
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TODD E. HANDEL, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 01/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 285 GOVERNOR ST STE 100
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02906-3237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-305-5280
-----------------------------------------------------
Fax | 401-305-5285
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 HIGHLAND AVE
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02906-2740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-305-5280
-----------------------------------------------------
Fax | 401-305-5285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN OWNER
-----------------------------------------------------
Name | TODD EVAN HANDEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 401-305-5280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | MD10599
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------