Provider Demographics
NPI:1851389720
Name:MAYO-SMITH, WILLIAM W (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:W
Last Name:MAYO-SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CATAMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1204
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-432-2457
Practice Address - Street 1:20 CATAMORE BLVD
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1204
Practice Address - Country:US
Practice Address - Phone:401-432-2520
Practice Address - Fax:401-432-2457
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI088472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
005221OtherBLUECHIP
008847OtherBLUESHIELD
3092879OtherHEALTHYSTART
000000001988OtherNHPRI
3092879OtherMASSMEDICAID
725009OtherTUFTS
1600241OtherUNITEDHEALTHPLANS
240093OtherRIHPILGRIM
7004723OtherRIMEDICALASSISTANCE
3092879OtherHEALTHYSTART