Provider Demographics
NPI:1417253568
Name:OBSTETRICS GYNECOLOGY AND MIDWIFERY OF NEWPORT
Entity Type:Organization
Organization Name:OBSTETRICS GYNECOLOGY AND MIDWIFERY OF NEWPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-846-5590
Mailing Address - Street 1:358 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1735
Mailing Address - Country:US
Mailing Address - Phone:401-846-5590
Mailing Address - Fax:401-848-7573
Practice Address - Street 1:358 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-1735
Practice Address - Country:US
Practice Address - Phone:401-846-5590
Practice Address - Fax:401-848-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty