Graduated: 1989
NPI: 1215915228
Practice Locations (3)
LIFESPAN PHYSICIAN GROUP INC
164 SUMMIT AVE
PROVIDENCE, RI 029062853
4017934300
THE MIRIAM HOSPITAL
164 SUMMIT AVE
PROVIDENCE, RI 029062894
4017938700
LIFESPAN PHYSICIAN GROUP INC
593 EDDY ST
PROVIDENCE, RI 029034923
Source: CMS National Downloadable File, September 2026.