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General NPI Number Information
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NPI Number | 1275733479
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Entity Type | Individual
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Provider Name | TRACEY ANNE BUFFUM MED
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Gender | Female
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 140 POINT JUDITH RD UNIT 44, J. TRUDEAU MEMORIAL CENTER
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City | NARRAGANSETT
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State | RI
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Zip | 02882-3451
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Country | US
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Telephone | 401-783-6853
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Fax |
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Provider Business Mailing Address
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Address Line | 20 GREENBRIAR PL
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City | KINGSTON
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State | RI
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Zip | 02881-1733
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Country | US
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Telephone | 401-284-3680
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Fax |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP00941
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License Number State | RI
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