1861480733 NPI number — DAMIAN EDWARD DUPUY MD

Table of content: DAMIAN EDWARD DUPUY MD (NPI 1861480733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861480733 NPI number — DAMIAN EDWARD DUPUY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUPUY
Provider First Name:
DAMIAN
Provider Middle Name:
EDWARD
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:
1861480733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 CATAMORE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02914-1204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-432-2520
Provider Business Mailing Address Fax Number:
401-432-2457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 CATAMORE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02914-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-432-2520
Provider Business Practice Location Address Fax Number:
401-432-2457
Provider Enumeration Date:
10/13/2005

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: 2085R0202X , with the licence number:  9357 , 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: 007005660 . This is a "HOSPITAL PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 009357 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 24554RIH . This is a "RIH PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 720052601 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 400497 . This is a "BLUE CHIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7005659 . This is a "RI MEDICAL ASSISTANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 795079 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003109544 . This is a "CT MED ASSISTANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000001988 . This is a "NHPRI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300067442 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3200671 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3200671 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1600203 . This is a "UNITED HEALTH PLANS" identifier . This identifiers is of the category "OTHER".




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