Provider Demographics
NPI:1790892123
Name:DUHAMEL, EDMOND
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:
Last Name:DUHAMEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 856
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:RI
Mailing Address - Zip Code:02826-0856
Mailing Address - Country:US
Mailing Address - Phone:401-567-0807
Mailing Address - Fax:
Practice Address - Street 1:215 TOLL GATE RD STE 205
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4461
Practice Address - Country:US
Practice Address - Phone:401-732-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPT01837OtherLICENSE #