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General NPI Number Information
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NPI Number | 1700928579
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Entity Type | Organization
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Legal Business Name | THE INDEPENDENT WOMAN, INC.
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 400 BALD HILL RD SUITE 508
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City | WARWICK
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State | RI
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Zip | 02886-1617
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Country | US
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Telephone | 401-384-6293
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Fax |
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Provider Business Mailing Address
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Address Line | 400 BALD HILL RD SUITE 508
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City | WARWICK
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State | RI
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Zip | 02886-1617
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Country | US
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Telephone | 401-384-6293
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MARY CATHERINE DEROSA
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Credential |
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Telephone | 401-384-6293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD07443
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License Number State | RI
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