Provider Demographics
NPI:1275667248
Name:STA INES, CASIMIRA CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CASIMIRA
Middle Name:CARLOS
Last Name:STA INES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MICHELLE CIR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-8592
Mailing Address - Country:US
Mailing Address - Phone:401-884-3942
Mailing Address - Fax:
Practice Address - Street 1:1526 ATWOOD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3289
Practice Address - Country:US
Practice Address - Phone:401-273-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD059652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology