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General NPI Number Information
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NPI Number | 1891288627
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Entity Type | Individual
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Provider Name | ANDREW MARC TAREILA MD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 593 EDDY ST
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City | PROVIDENCE
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State | RI
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Zip | 02903-4923
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Country | US
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Telephone | 401-444-5127
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Fax | 401-444-3056
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Provider Business Mailing Address
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Address Line | 125 METRO CENTER BLVD
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City | WARWICK
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State | RI
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Zip | 02886-1768
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Country | US
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Telephone | 401-432-2500
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Fax | 401-921-9212
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD17185
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License Number State | RI
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