Provider Demographics
NPI:1205112935
Name:STEPHEN J D'AMATO MD PC
Entity type:Organization
Organization Name:STEPHEN J D'AMATO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:D'AMATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-270-7077
Mailing Address - Street 1:211 QUAKER LN
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-2151
Mailing Address - Country:US
Mailing Address - Phone:401-270-7077
Mailing Address - Fax:401-270-2781
Practice Address - Street 1:211 QUAKER LN
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-2151
Practice Address - Country:US
Practice Address - Phone:401-270-7077
Practice Address - Fax:401-270-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05562208VP0000X, 207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0410540001OtherDME
1203-0OtherBCROSS
RI9001203Medicaid
RI00002400188 03OtherUHC
RI0410540001OtherDME