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General NPI Number Information
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NPI Number | 1578424602
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Entity Type | Organization
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Legal Business Name | LIFESPAN PHYSICIAN GROUP INC
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Dates
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Enumeration Date | 11/19/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 110 ELM ST
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City | PROVIDENCE
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State | RI
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Zip | 02903-4626
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Country | US
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Telephone | 401-444-7959
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Fax |
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Provider Business Mailing Address
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Address Line | 15 LA SALLE SQ
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City | PROVIDENCE
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State | RI
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Zip | 02903-1814
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT REVENUE CYCLE
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Name | CHRISTINE RAWNSLEY
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Credential |
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Telephone | 401-444-6905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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