Provider Demographics
NPI:1619901147
Name:FIELDS, CLIFFORD J (DO)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:J
Last Name:FIELDS
Suffix:
Gender:M
Credentials:DO
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 STE 103
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4451
Mailing Address - Country:US
Mailing Address - Phone:401-829-4446
Mailing Address - Fax:401-829-4434
Practice Address - Street 1:725 RESERVOIR AVE STE 103
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4451
Practice Address - Country:US
Practice Address - Phone:401-829-4446
Practice Address - Fax:401-829-4434
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO2808207P00000X
RIDO 00356207P00000X
MA74935207P00000X
RIDO00356207QA0401X, 2084A0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDO00356OtherOSTEOPATHIC PHYSICIAN