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General NPI Number Information
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NPI Number | 1780024687
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Entity Type | Organization
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Legal Business Name | OCEAN STATE DERMATOLOGY, INC
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Dates
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Enumeration Date | 06/25/2013
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 300 JEFFERSON BLVD SUITE #305
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City | WARWICK
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State | RI
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Zip | 02888-3888
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Country | US
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Telephone | 401-739-7546
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Fax | 401-739-7544
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Provider Business Mailing Address
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Address Line | 300 JEFFERSON BLVD SUITE #305
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City | WARWICK
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State | RI
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Zip | 02888-3888
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Country | US
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Telephone | 401-739-7545
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Fax | 401-739-7544
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANA P. HALL
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Credential | M.D.
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Telephone | 401-739-7546
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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 | MD11167
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License Number State | RI
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