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General NPI Number Information
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NPI Number | 1396728200
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Entity Type | Individual
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Provider Name | MARSHALL BENJAMIN WOLD MD
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Gender | Male
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 610 WAMPANOAG TRL
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City | RIVERSIDE
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State | RI
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Zip | 02915-1504
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Country | US
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Telephone | 401-431-9870
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Fax | 401-435-7486
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Provider Business Mailing Address
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Address Line | 36 MIDDLE HWY
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City | BARRINGTON
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State | RI
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Zip | 02806-1205
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Country | US
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Telephone | 401-241-7736
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Fax | 401-435-7486
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | MD10337
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License Number State | RI
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