1902881337 NPI number — STEVEN M OPAL MD

Table of content: STEVEN M OPAL MD (NPI 1902881337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902881337 NPI number — STEVEN M OPAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OPAL
Provider First Name:
STEVEN
Provider Middle Name:
M
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:
1902881337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 BREWSTER STREET,
Provider Second Line Business Mailing Address:
MEMORIAL HOSPITAL OF RI WOOD 516
Provider Business Mailing Address City Name:
PAWTUCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02860-4400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-729-2250
Provider Business Mailing Address Fax Number:
401-729-2721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 BREWSTER ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF INFECTIOUS DISEASE
Provider Business Practice Location Address City Name:
PAWTUCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02860-4400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-729-2545
Provider Business Practice Location Address Fax Number:
401-729-2795
Provider Enumeration Date:
12/08/2005

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: 207R00000X , with the licence number:  MD06676 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: MD06676 , 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: 110087819A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9006270 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".