Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD04779 | RI |
NPI | 1083719819 |
---|---|
Provider Name | Joseph Demartino |
First Address | Providence, RI 02905-3240 |
Second Address | Providence, RI 02905-3240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |