Provider Demographics
NPI:1477538411
Name:SARIS, STEPHEN CLAYTON (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CLAYTON
Last Name:SARIS
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 1:3 DAVOL SQUARE
Mailing Address - Street 2:SUITE B200
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4762
Mailing Address - Country:US
Mailing Address - Phone:401-453-3545
Mailing Address - Fax:401-453-3533
Practice Address - Street 1:3 DAVOL SQUARE
Practice Address - Street 2:SUITE B200
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4762
Practice Address - Country:US
Practice Address - Phone:401-453-3545
Practice Address - Fax:401-543-3533
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD 08444207T00000X
MA71248207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI25614 2OtherBLUE CROSS
AS8844756002OtherCIGNA GROUP VENDOR
203537OtherBLUE CHIP
MAJ08735OtherBLUE CROSS
2060540OtherAETNE/ US HEALTHCARE
3051790OtherMASS HEALTH
12266RIHOtherHARVARD PILGRIM
638092003OtherCIGNA PAL
1156OtherNEIGHBORHOOD HEALTH PLAN
720118301OtherCIGNA
MA0018978OtherNEIGHBORHOOD HEALTH PLAN
05 0501339OtherTAX ID
7003375OtherEDS OF RI INDIV
05 0501339OtherHEALTHCARE VALUE MANAG
003I05328OtherEDS OF CT
NS34351OtherEDS OF RI GROUP
NS34351OtherEDS OF RI GROUP
MASA J 8735Medicare ID - Type Unspecified
7003375OtherEDS OF RI INDIV
NS34351OtherEDS OF RI GROUP