Provider Demographics
NPI:1710983366
Name:FOREMAN, DOUGLAS SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:SCOTT
Last Name:FOREMAN
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 1:1444 WARWICK AVE.,
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888
Mailing Address - Country:US
Mailing Address - Phone:401-463-5750
Mailing Address - Fax:401-463-7760
Practice Address - Street 1:1444 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-5026
Practice Address - Country:US
Practice Address - Phone:401-463-5750
Practice Address - Fax:401-463-7760
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO-326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI050465635OtherEIN
RI019003082Medicare PIN
RI050465635OtherEIN