Provider Demographics
NPI:1720081441
Name:STAUDINGER, KATHLEEN M (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:STAUDINGER
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 1:5 PADDOCK DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4947
Mailing Address - Country:US
Mailing Address - Phone:401-728-9737
Mailing Address - Fax:
Practice Address - Street 1:38 HAMLET AVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4423
Practice Address - Country:US
Practice Address - Phone:401-762-0020
Practice Address - Fax:401-762-1819
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD064742085R0202X, 2085U0001X, 2085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Not Answered2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9108416OtherCIGNA
RI006474OtherTUFTS TGR
MA3142388Medicaid
RIMD06474OtherRI LICENSE
RI1198-5OtherBCBS TGR OFFICE
RI1570-5OtherBCBS KENT TGR
RIP00110434OtherRR MEDICARE TGR
MA58647OtherMA LICENSE
RI7000916Medicaid
RI756624OtherCONNECTICARE TGR
RI400752OtherBLUE CHIP TGR
RI2203OtherNHP TGR
RI7321658OtherAETNA
E93729Medicare UPIN