Provider Demographics
NPI:1245227768
Name:SCHOENFELD, LARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:SCHOENFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DAVOL SQ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4754
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:900 WARREN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1430
Practice Address - Country:US
Practice Address - Phone:401-331-1221
Practice Address - Fax:401-751-8003
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05685207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI110039300OtherRR MEDICARE
RI709003711OtherGROUP MEDICARE
RI7000365Medicaid
RI7000365Medicaid
RI007056796Medicare PIN