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General NPI Number Information
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NPI Number | 1811074909
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Entity Type | Individual
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Provider Name | PHILEMON T MARVELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 2 WAKE ROBIN RD SUITE 208
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City | LINCOLN
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State | RI
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Zip | 02865-4295
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Country | US
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Telephone | 401-475-7650
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Fax | 401-475-7655
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Provider Business Mailing Address
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Address Line | 552 W MAIN RD
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City | LITTLE COMPTON
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State | RI
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Zip | 02837-1123
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Country | US
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Telephone | 401-592-0137
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 41799
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD05394
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License Number State | RI
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