Provider Demographics
NPI:1023193281
Name:STUART, SUSAN M (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:STUART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2924
Mailing Address - Country:US
Mailing Address - Phone:401-596-0174
Mailing Address - Fax:401-596-2266
Practice Address - Street 1:45 WELLS ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2927
Practice Address - Country:US
Practice Address - Phone:401-596-3229
Practice Address - Fax:401-596-0850
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI0486208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI000486OtherTUFTS
RI040000486RI01OtherANTHEM
RI000486OtherTUFTS