Provider Demographics
NPI:1841354982
Name:WEST BAY DERMATOLOGY, LTD
Entity type:Organization
Organization Name:WEST BAY DERMATOLOGY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-885-4100
Mailing Address - Street 1:1672 S COUNTY TRL STE 202
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5099
Mailing Address - Country:US
Mailing Address - Phone:401-885-4100
Mailing Address - Fax:401-885-4130
Practice Address - Street 1:1672 S COUNTY TRL STE 202
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5099
Practice Address - Country:US
Practice Address - Phone:401-885-4100
Practice Address - Fax:401-885-4130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI070015999OtherRAILROAD MEDICARE
RI21994-1OtherBLUE CROSS BLUE SHIELD
RIWE34797Medicaid
RI202353OtherBLUE CHIP
RI=========3002OtherUNITED HEALTHCARE
RIWE34797Medicaid
RI=========3002OtherUNITED HEALTHCARE