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General NPI Number Information
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NPI Number | 1992329692
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Entity Type | Individual
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Provider Name | FATIH KOKDERE MD
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Gender | Male
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 345 BLACKSTONE BLVD
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City | PROVIDENCE
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State | RI
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Zip | 02906-4800
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Country | US
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Telephone | 401-455-6200
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Fax | 401-455-6689
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Provider Business Mailing Address
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Address Line | PO BOX 1475
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City | DES MOINES
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State | IA
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Zip | 50305-1475
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Country | US
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Telephone | 515-643-2682
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Fax | 515-643-5802
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD19761
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | R-11738
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License Number State | IA
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