Provider Demographics
NPI:1588045090
Name:LE, HUNG MANH (MD)
Entity Type:Individual
Prefix:
First Name:HUNG
Middle Name:MANH
Last Name:LE
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 1:450 BROOK ST
Mailing Address - Street 2:BOX 1928
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2231
Mailing Address - Country:US
Mailing Address - Phone:401-863-7893
Mailing Address - Fax:
Practice Address - Street 1:450 BROOK ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2231
Practice Address - Country:US
Practice Address - Phone:401-863-7893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA273080207R00000X, 207RS0010X
RIMD17977207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine