Provider Demographics
NPI:1043405863
Name:BERMUDEZ-EMMANUELLI, ROSA H (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:H
Last Name:BERMUDEZ-EMMANUELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSA
Other - Middle Name:H
Other - Last Name:BERMUDEZ EMMANUELLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4513
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:148 W RIVER ST STE 8
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904
Practice Address - Country:US
Practice Address - Phone:401-606-3000
Practice Address - Fax:401-331-8110
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242188207V00000X
RIMD14724207V00000X
PR17168207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology