Provider Demographics
NPI:1669579702
Name:AQUIDNECK RADIOLOGISTS, INC.
Entity type:Organization
Organization Name:AQUIDNECK RADIOLOGISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:401-845-1338
Mailing Address - Street 1:39 LONG WHARF MALL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2906
Mailing Address - Country:US
Mailing Address - Phone:401-845-1338
Mailing Address - Fax:401-848-6008
Practice Address - Street 1:11 FRIENDSHIP ST
Practice Address - Street 2:NEWPORT HOSPITAL
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2209
Practice Address - Country:US
Practice Address - Phone:401-845-1338
Practice Address - Fax:401-848-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000120Medicaid