1811023401 NPI number — MRS. ELAINE MARIE DEEGAN MS OTRL

Table of content: MRS. ELAINE MARIE DEEGAN MS OTRL (NPI 1811023401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811023401 NPI number — MRS. ELAINE MARIE DEEGAN MS OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEEGAN
Provider First Name:
ELAINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS OTRL
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:
1811023401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3449 POST RD
Provider Second Line Business Mailing Address:
TRUDEAU CENTER
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-739-2700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 COMMERCIAL AVE
Provider Second Line Business Practice Location Address:
TRUDEAU EI
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-823-1731
Provider Business Practice Location Address Fax Number:
401-823-1849
Provider Enumeration Date:
02/26/2007

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: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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