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General NPI Number Information
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NPI Number | 1831362813
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Entity Type | Organization
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Legal Business Name | THE MIRIAM HOSPITAL
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 180 CORLISS ST STE C
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City | PROVIDENCE
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State | RI
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Zip | 02904-2602
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Country | US
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Telephone | 401-793-4636
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Fax | 401-793-4639
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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 | 401-444-5462
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Authorized Official
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Title or Position | E VP & CFO
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Name | PETER K MARKELL
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Credential |
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Telephone | 401-444-7914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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