Provider Demographics
NPI:1891701116
Name:SALLOWAY, STEPHEN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:SALLOWAY
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 1:345 BLACKSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4800
Mailing Address - Country:US
Mailing Address - Phone:401-455-6200
Mailing Address - Fax:401-455-6309
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:401-455-6200
Practice Address - Fax:401-455-6309
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD080192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI22109-2OtherBLUE CROSS
RI1093831646OtherBUTLER HOSPITAL PROFESSIONAL BILLING OFFICE
RI1104801349OtherBUTLER HOSPITAL NPI
RI7002095Medicaid
RI05-00337OtherUNITED HEALTHCARE
RI202446OtherBLUE CHIP
RIP00141985OtherMEDICARE RAILROAD
RI22109-2OtherBLUE CROSS
RIP00141985OtherMEDICARE RAILROAD