Provider Demographics
NPI:1770591190
Name:ROUSE, DWIGHT J (MD, MSPH)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:J
Last Name:ROUSE
Suffix:
Gender:M
Credentials:MD, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-274-1122
Mailing Address - Fax:401-453-7622
Practice Address - Street 1:101 PLAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4828
Practice Address - Country:US
Practice Address - Phone:401-274-1122
Practice Address - Fax:401-453-7622
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD13078207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009970485Medicaid
AL009970495Medicaid
AL051521267OtherBLUE CROSS
AL000093716OtherBLUE CROSS
AL009952725Medicaid
AL051521268OtherBLUE CROSS
AL000084538OtherBLUE CROSS
AL000084538Medicaid
AL009936015Medicaid
AL009952745Medicaid
AL009970475Medicaid
AL051521269OtherBLUE CROSS
AL000093716Medicaid
AL051518077OtherBLUE CROSS
AL009952705Medicaid
AL051521270OtherBLUE CROSS
AL009952735Medicaid
AL051521271OtherBLUE CROSS
AL009952695Medicaid
AL009952715Medicaid