1720081441 NPI number — KATHLEEN M STAUDINGER MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720081441 NPI number — KATHLEEN M STAUDINGER MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

STAUDINGER

Provider First Name:

KATHLEEN

Provider Middle Name:

M

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1720081441

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

5 PADDOCK DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

LINCOLN

Provider Business Mailing Address State Name:

RI

Provider Business Mailing Address Postal Code:

02865-4947

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

401-728-9737

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

38 HAMLET AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WOONSOCKET

Provider Business Practice Location Address State Name:

RI

Provider Business Practice Location Address Postal Code:

02895-4423

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

401-762-0020

Provider Business Practice Location Address Fax Number:

401-762-1819

Provider Enumeration Date:

05/27/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  MD06474 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
• Taxonomy code: 2085U0001X , with the licence number: MD06474 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
• Taxonomy code: 2085N0904X , with the licence number: MD06474 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

• Identifier: 9108416 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 006474 . This is a "TUFTS TGR" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 3142388 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: MD06474 . This is a "RI LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 1198-5 . This is a "BCBS TGR OFFICE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 1570-5 . This is a "BCBS KENT TGR" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: P00110434 . This is a "RR MEDICARE TGR" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 58647 . This is a "MA LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 7000916 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
• Identifier: 756624 . This is a "CONNECTICARE TGR" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 400752 . This is a "BLUE CHIP TGR" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 2203 . This is a "NHP TGR" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 7321658 . This is a "AETNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".