Provider Demographics
NPI:1245350958
Name:UNIVERSITY OTOLARYNGOLOGY-HEAD AND NECK SURGERY, INC.
Entity type:Organization
Organization Name:UNIVERSITY OTOLARYNGOLOGY-HEAD AND NECK SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-885-8484
Mailing Address - Street 1:1351 S COUNTY TRL STE 304
Mailing Address - Street 2:
Mailing Address - City:E GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5083
Mailing Address - Country:US
Mailing Address - Phone:401-885-8484
Mailing Address - Fax:401-232-8057
Practice Address - Street 1:830 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4810
Practice Address - Country:US
Practice Address - Phone:401-274-2300
Practice Address - Fax:401-232-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD03762207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU020134Medicaid
RI049005810Medicare PIN