Provider Demographics
NPI:1922089358
Name:NOGUEIRA, JENNIFER ANN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:NOGUEIRA
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 1:20 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:RHODE ISLAND MEDICAL IMAGING
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:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI103592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0158551OtherMASSMEDICAID
16 00025OtherUNITED HEALTH PLANS
10359OtherBLUE SHIELD
010359OtherTUFTS
000000001988OtherNHPRI
0158551OtherHEALTHY START
AA26534OtherRIH PILGRIM
407647OtherBLUE CHIP
7008277OtherRI MEDICAL ASSISTANCE
4833011OtherCIGNA
PAROtherAETNA
16 00025OtherUNITED HEALTH PLANS