Provider Demographics
NPI:1477885424
Name:MOOMIAIE, REMO (MD)
Entity Type:Individual
Prefix:
First Name:REMO
Middle Name:
Last Name:MOOMIAIE
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 1:137 DOYLE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1609
Mailing Address - Country:US
Mailing Address - Phone:631-258-4070
Mailing Address - Fax:
Practice Address - Street 1:137 DOYLE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1609
Practice Address - Country:US
Practice Address - Phone:631-258-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLIMITED LICENCE208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery