Provider Demographics
NPI:1982639415
Name:BOVIE, WARREN W (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:W
Last Name:BOVIE
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 1:21 PEACE ST
Mailing Address - Street 2:SUITE 251 EAST
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1510
Mailing Address - Country:US
Mailing Address - Phone:401-456-4215
Mailing Address - Fax:401-456-3019
Practice Address - Street 1:200 HIGH SERVICE AVE
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5113
Practice Address - Country:US
Practice Address - Phone:401-456-4215
Practice Address - Fax:401-456-3019
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD045812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2097567Medicaid
RI0097754Medicaid
RI0097754Medicaid