Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 6028 | RI |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 6028 | RI |
NPI | 1215911367 |
---|---|
Provider Name | Donald R Coustan |
First Address | Providence, RI 02905-2401 |
Second Address | Providence, RI 02905-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7003805 | (05) | RI |
C90045 | (02) |