Provider Demographics
NPI:1639166655
Name:BOTELHO, DENNIS D (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:D
Last Name:BOTELHO
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 6A
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4450
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:725 RESERVOIR AVE STE 6A
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4450
Practice Address - Country:US
Practice Address - Phone:401-942-2320
Practice Address - Fax:401-942-2375
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08630207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIF77173Medicare UPIN
RI007057467Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER