Provider Demographics
NPI:1417982604
Name:ROSOL, RICHARD LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEWIS
Last Name:ROSOL
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 1:226 ATWELLS AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-1528
Mailing Address - Country:US
Mailing Address - Phone:401-217-0077
Mailing Address - Fax:401-217-0079
Practice Address - Street 1:226 ATWELLS AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-1528
Practice Address - Country:US
Practice Address - Phone:207-778-0482
Practice Address - Fax:207-779-2303
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD14760208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEH76893Medicare UPIN
MEMM9785Medicare ID - Type Unspecified