Provider Demographics
NPI:1144241613
Name:ABBOTT, JINNETTE DAWN (MD)
Entity Type:Individual
Prefix:MRS
First Name:JINNETTE
Middle Name:DAWN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DUDLEY ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905
Mailing Address - Country:US
Mailing Address - Phone:401-444-4581
Mailing Address - Fax:401-444-8158
Practice Address - Street 1:2 DUDLEY ST
Practice Address - Street 2:SUITE 360
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905
Practice Address - Country:US
Practice Address - Phone:401-444-4581
Practice Address - Fax:401-444-8158
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11487207RC0000X
RI11487207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003694Medicaid
RI9003694Medicaid
RI709003694Medicare ID - Type Unspecified