Provider Demographics
NPI:1427004886
Name:RHODE ISLAND DERMATOLOGY AND LASER MEDICINE
Entity Type:Organization
Organization Name:RHODE ISLAND DERMATOLOGY AND LASER MEDICINE
Other - Org Name:RHODE ISLAND DERMATOLOGY AND LASER MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-521-7300
Mailing Address - Street 1:845 N MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5700
Mailing Address - Country:US
Mailing Address - Phone:401-521-7300
Mailing Address - Fax:401-521-7307
Practice Address - Street 1:845 N MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5700
Practice Address - Country:US
Practice Address - Phone:401-521-7300
Practice Address - Fax:401-521-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD6829207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty