Provider Demographics
NPI:1891831764
Name:AQUIDNECK MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:AQUIDNECK MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALLING
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-847-2290
Mailing Address - Street 1:50 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840
Mailing Address - Country:US
Mailing Address - Phone:401-847-2290
Mailing Address - Fax:401-849-8446
Practice Address - Street 1:50 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840
Practice Address - Country:US
Practice Address - Phone:401-847-2290
Practice Address - Fax:401-849-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty