Provider Demographics
NPI:1396728200
Name:WOLD, MARSHALL BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:BENJAMIN
Last Name:WOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MIDDLE HWY
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1205
Mailing Address - Country:US
Mailing Address - Phone:401-241-7736
Mailing Address - Fax:401-435-7486
Practice Address - Street 1:610 WAMPANOAG TRL
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1504
Practice Address - Country:US
Practice Address - Phone:401-431-9870
Practice Address - Fax:401-435-7486
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD103372084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI25677-7OtherBC/BS OF RI
RI15-61526OtherUBH
RI408303OtherBLUE CHIP
RI7058679Medicaid
RI408303OtherBLUE CHIP
RIF35615Medicare UPIN