Provider Demographics
NPI:1487674404
Name:SPOSATO, SERENA (MD)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:SPOSATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 PLAIN ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3240
Mailing Address - Country:US
Mailing Address - Phone:401-521-1522
Mailing Address - Fax:401-453-1528
Practice Address - Street 1:235 PLAIN ST
Practice Address - Street 2:SUITE 307
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3240
Practice Address - Country:US
Practice Address - Phone:401-521-1522
Practice Address - Fax:401-453-1528
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD7647207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1487674404Medicaid
RI1487674404Medicaid