Provider Demographics
NPI:1790032746
Name:SUSAN M. STUART, DO, INC.
Entity Type:Organization
Organization Name:SUSAN M. STUART, DO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-596-0174
Mailing Address - Street 1:46 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2924
Mailing Address - Country:US
Mailing Address - Phone:401-596-0174
Mailing Address - Fax:401-596-2266
Practice Address - Street 1:46 WELLS ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2924
Practice Address - Country:US
Practice Address - Phone:401-596-0174
Practice Address - Fax:401-596-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00486208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty