1134257348 NPI number — DR. KATHLEEN RAE DONISE MD

Table of content: DR. HOWARD LINCOLN TICE MD (NPI 1215998505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134257348 NPI number — DR. KATHLEEN RAE DONISE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONISE
Provider First Name:
KATHLEEN
Provider Middle Name:
RAE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134257348
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RHODE ISLAND HOSPITAL, MOC BLDG SUITE 460
Provider Second Line Business Mailing Address:
2 DUDLEY STREET
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-444-4779
Provider Business Mailing Address Fax Number:
401-519-2963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RHODE ISLAND HOSPITAL
Provider Second Line Business Practice Location Address:
593 EDDY STREET
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-444-4779
Provider Business Practice Location Address Fax Number:
401-519-2963
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  MA88231 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: MD11892 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MA88231 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: MD11892 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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