Provider Demographics
NPI:1619062411
Name:OPALENSKI, PHILIP JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JOSEPH
Last Name:OPALENSKI
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 1:725 RESERVOIR AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910
Mailing Address - Country:US
Mailing Address - Phone:401-943-7222
Mailing Address - Fax:401-944-7430
Practice Address - Street 1:725 RESERVOIR AVE
Practice Address - Street 2:STE 205
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910
Practice Address - Country:US
Practice Address - Phone:401-943-7222
Practice Address - Fax:401-944-7430
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI5679207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9001120Medicaid
RI9001120Medicaid
109001120Medicare ID - Type Unspecified