MEDICARE: JOANN D. MACMILLAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	5410	RI
2	207Y00000X	Otolaryngology Physician	5410	RI

General Provider Information

NPI Number	:	1821002130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANN D. MACMILLAN M.D.

Provider Business Mailing Address
First Line	:	300 TOLL GATE RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-4416
Country	:	US
Telephone Number	:	401-732-1330
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 TOLL GATE RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-4416
Country	:	US
Telephone Number	:	401-732-1330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	12/15/2016

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