Provider Demographics
NPI:1508812165
Name:NOWAK, MARIOLA M (MD)
Entity Type:Individual
Prefix:
First Name:MARIOLA
Middle Name:M
Last Name:NOWAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 S COUNTY TRL
Mailing Address - Street 2:SUITE 303
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5098
Mailing Address - Country:US
Mailing Address - Phone:401-884-0020
Mailing Address - Fax:401-884-0019
Practice Address - Street 1:1672 S COUNTY TRL
Practice Address - Street 2:SUITE 303
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5098
Practice Address - Country:US
Practice Address - Phone:401-884-0020
Practice Address - Fax:401-884-0019
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI9605207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9025605Medicaid
RI9025605Medicaid
RI7009496Medicare ID - Type Unspecified