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General NPI Number Information
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NPI Number | 1679054043
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Entity Type | Individual
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Provider Name | CARLOS G WAMBIER MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 65 VILLAGE SQUARE DR STE 201
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City | SOUTH KINGSTOWN
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State | RI
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Zip | 02879-2292
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Country | US
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Telephone | 401-738-1120
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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 | 401-444-6779
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Fax | 401-444-6912
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD17358
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License Number State | RI
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