Provider Demographics
NPI:1780024687
Name:OCEAN STATE DERMATOLOGY, INC
Entity Type:Organization
Organization Name:OCEAN STATE DERMATOLOGY, INC
Other - Org Name:OCEAN STATE DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-739-7546
Mailing Address - Street 1:300 JEFFERSON BLVD
Mailing Address - Street 2:SUITE #305
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3888
Mailing Address - Country:US
Mailing Address - Phone:401-739-7545
Mailing Address - Fax:401-739-7544
Practice Address - Street 1:300 JEFFERSON BLVD
Practice Address - Street 2:SUITE #305
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3888
Practice Address - Country:US
Practice Address - Phone:401-739-7546
Practice Address - Fax:401-739-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11167207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty