Provider Demographics
NPI:1154734580
Name:YOUR HEALTH
Entity type:Organization
Organization Name:YOUR HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUNAWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-398-2656
Mailing Address - Street 1:8 MACERA CIR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-8593
Mailing Address - Country:US
Mailing Address - Phone:401-398-2656
Mailing Address - Fax:
Practice Address - Street 1:1407 S COUNTY TRL
Practice Address - Street 2:UNIT 422
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1652
Practice Address - Country:US
Practice Address - Phone:401-398-2656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD09436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2040325OtherNEIGHBORHOOD HEALTH PLAN OF RI