Provider Demographics
NPI:1073833257
Name:STUDDERS, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:STUDDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 THURBER BLVD
Mailing Address - Street 2:UNIT 6
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-1816
Mailing Address - Country:US
Mailing Address - Phone:401-404-2975
Mailing Address - Fax:401-404-2976
Practice Address - Street 1:19 FRIENDSHIP ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2200
Practice Address - Country:US
Practice Address - Phone:401-404-2975
Practice Address - Fax:401-404-2976
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05611174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIC90643Medicare UPIN