Provider Demographics
NPI:1891860029
Name:SOWA, MARTA S (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:S
Last Name:SOWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BLACKSTONE VALLEY PLACE
Mailing Address - Street 2:SUITE 306B
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865
Mailing Address - Country:US
Mailing Address - Phone:401-334-4021
Mailing Address - Fax:401-334-4886
Practice Address - Street 1:6 BLACKSTONE VALLEY PLACE
Practice Address - Street 2:SUITE 306B
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865
Practice Address - Country:US
Practice Address - Phone:401-334-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52825208000000X
RIMD6923208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7003409Medicaid
E03316Medicare UPIN