Provider Demographics
NPI:1821053653
Name:WAZER, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:WAZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:DEPARTMENT OF RADIATION ONCOLOGY
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-8311
Mailing Address - Fax:401-444-5335
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:DEPARTMENT OF RADIATION ONCOLOGY
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-8311
Practice Address - Fax:401-444-5335
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA00-594082085R0001X
RIMD096742085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4804-8OtherBLUE CROSS BLUE SHIELD
RI7006674Medicaid
MA709180OtherTUFTS HEALTH PLAN
RI2400030OtherUNITED HEALTHCARE
RIP00762784OtherRAILROAD MEDICARE - RADIOSURGERY CENTER OF RI
MA3032477Medicaid
RI0190162OtherCIGNA
RIA66566Medicare UPIN
RI7006674Medicaid
RIP00762784OtherRAILROAD MEDICARE - RADIOSURGERY CENTER OF RI