Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD13391 | RI |
NPI | 1053530782 |
---|---|
Provider Name | Simone Thavaseelan |
First Address | Providence, RI 02904-1869 |
Second Address | Providence, RI 02905-3247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 14/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1659463230 | GROUP NPI (01) | |
349005986 | MEDICARE GROUP PTAN (01) | RI |