Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080A0000X | Adolescent Medicine | MD03912 | RI |
NPI | 1225080617 |
---|---|
Provider Name | Roger Ashley |
First Address | Fall River, MA 02723-1516 |
Second Address | Wakefield, RI 02879-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7001915 | (05) | RI |
E34068 | (02) | RI |