Provider Demographics
NPI:1275836165
Name:XU, DAWSON (PA)
Entity Type:Individual
Prefix:
First Name:DAWSON
Middle Name:
Last Name:XU
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:DAOSONG
Other - Middle Name:
Other - Last Name:XU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 9484
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-9484
Mailing Address - Country:US
Mailing Address - Phone:401-854-2500
Mailing Address - Fax:401-854-2519
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-519-1604
Practice Address - Fax:401-272-0538
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00571363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI04112011OtherBCBSRI
RIDX83438Medicaid
RI0019876OtherRI MEDICARE
RI03102011OtherNHPRI
RI939025129OtherRI MEDICARE GROUP