Provider Demographics
NPI:1750437448
Name:MADDOCK, PHILIP G (MD, FRCR)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:G
Last Name:MADDOCK
Suffix:
Gender:M
Credentials:MD, FRCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2715
Mailing Address - Country:US
Mailing Address - Phone:401-732-2300
Mailing Address - Fax:401-738-3450
Practice Address - Street 1:450 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2715
Practice Address - Country:US
Practice Address - Phone:401-732-2300
Practice Address - Fax:401-738-3450
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD061592085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000354Medicaid
RI9000354Medicaid