1477538411 NPI number — STEPHEN CLAYTON SARIS MD

Table of content: KATHERINE HANEY (NPI 1780002402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477538411 NPI number — STEPHEN CLAYTON SARIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARIS
Provider First Name:
STEPHEN
Provider Middle Name:
CLAYTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1477538411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 DAVOL SQUARE
Provider Second Line Business Mailing Address:
SUITE B200
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02903-4762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-453-3545
Provider Business Mailing Address Fax Number:
401-453-3533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 DAVOL SQUARE
Provider Second Line Business Practice Location Address:
SUITE B200
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903-4762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-453-3545
Provider Business Practice Location Address Fax Number:
401-543-3533
Provider Enumeration Date:
12/13/2005

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: 207T00000X , with the licence number:  MD 08444 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207T00000X , with the licence number: 71248 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 25614 2 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: AS8844756002 . This is a "CIGNA GROUP VENDOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203537 . This is a "BLUE CHIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: J08735 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2060540 . This is a "AETNE/ US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3051790 . This is a "MASS HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12266RIH . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 638092003 . This is a "CIGNA PAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1156 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 720118301 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0018978 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 05 0501339 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7003375 . This is a "EDS OF RI INDIV" identifier . This identifiers is of the category "OTHER".
  • Identifier: 05 0501339 . This is a "HEALTHCARE VALUE MANAG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003I05328 . This is a "EDS OF CT" identifier . This identifiers is of the category "OTHER".
  • Identifier: NS34351 . This is a "EDS OF RI GROUP" identifier . This identifiers is of the category "OTHER".




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