Provider Demographics
NPI:1750341228
Name:SIMMONS, ROXANNE MARIE (MD)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:MARIE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 BLACKSTONE VALLEY PL
Mailing Address - Street 2:SUITE 702
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1179
Mailing Address - Country:US
Mailing Address - Phone:401-334-1200
Mailing Address - Fax:401-334-1111
Practice Address - Street 1:6 BLACKSTONE VALLEY PL STE 500
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1102
Practice Address - Country:US
Practice Address - Phone:401-334-1200
Practice Address - Fax:401-334-1111
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2019-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIMD08908208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G08835Medicare UPIN