Provider Demographics
NPI:1285674614
Name:POULIOT, MONIQUE L (DO)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:L
Last Name:POULIOT
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 1:481 KINGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3626
Mailing Address - Country:US
Mailing Address - Phone:401-789-0283
Mailing Address - Fax:401-789-0314
Practice Address - Street 1:481 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3626
Practice Address - Country:US
Practice Address - Phone:401-789-0283
Practice Address - Fax:401-789-0314
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0402439OtherUNITEDHEALTHCARE
RI204786OtherBLUE CHIP HMORI
RIRI431OtherBLUE CROSS LICENSE
RI7006057Medicaid
RIDO00431OtherSTATE LICENSE
RI0402439OtherUNITEDHEALTHCARE
RI204786OtherBLUE CHIP HMORI