Provider Demographics
NPI:1861480733
Name:DUPUY, DAMIAN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:EDWARD
Last Name:DUPUY
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?:No
Enumeration Date:2005-10-13
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI93572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
007005660OtherHOSPITAL PIN
009357OtherBCBS
24554RIHOtherRIH PILGRIM
720052601OtherCIGNA
400497OtherBLUE CHIP
7005659OtherRI MEDICAL ASSISTANCE
795079OtherTUFTS
003109544OtherCT MED ASSISTANCE
000000001988OtherNHPRI
300067442OtherRR MEDICARE
3200671OtherHEALTHY START
MA3200671Medicaid
1600203OtherUNITED HEALTH PLANS
3200671OtherHEALTHY START
7005659OtherRI MEDICAL ASSISTANCE