Provider Demographics
NPI:1982657805
Name:O'BELL, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:O'BELL
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 1:110 ELM ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4626
Mailing Address - Country:US
Mailing Address - Phone:877-771-7401
Mailing Address - Fax:401-784-4902
Practice Address - Street 1:375 WAMPANOAG TRL
Practice Address - Street 2:SUITE 302A
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2232
Practice Address - Country:US
Practice Address - Phone:401-649-4060
Practice Address - Fax:401-649-4061
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11473207RN0300X
MA205573207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7056844Medicaid
MA2094461Medicaid
RI007056844Medicare PIN