Provider Demographics
NPI:1780697011
Name:LENIHAN, RUSSELL (PA)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:
Last Name:LENIHAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 WELLS STREET
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891
Mailing Address - Country:US
Mailing Address - Phone:401-596-0174
Mailing Address - Fax:401-596-2266
Practice Address - Street 1:46 WELLS STREET
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891
Practice Address - Country:US
Practice Address - Phone:401-596-0174
Practice Address - Fax:401-596-2266
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00075OtherRI LICENSE
PA00075OtherRI LICENSE
RI007003968Medicare PIN