Provider Demographics
NPI:1922099472
Name:DUGAS, EDWARD B (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:B
Last Name:DUGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:E
Other - Middle Name:BRIEN
Other - Last Name:DUGAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:70 KENYON AVE UNIT 324
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4253
Mailing Address - Country:US
Mailing Address - Phone:401-782-1199
Mailing Address - Fax:401-782-1120
Practice Address - Street 1:70 KENYON AVE UNIT 324
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4253
Practice Address - Country:US
Practice Address - Phone:401-782-1199
Practice Address - Fax:401-782-1120
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI07261207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2900262OtherUNITED HEALTHCARE OF NEW ENGLAND, INC.
RI9025424Medicaid
RI254241OtherBCBS
0004418722OtherAETNA
761747OtherFIRST HEALTH LIFE AND HEALTH INSURANCE CO.
2900262OtherUNITED HEALTHCARE OF NEW ENGLAND, INC.
0004418722OtherAETNA