Graduated: 1982
NPI: 1417944190
Practice Locations (3)
COASTAL MEDICAL PHYSICIANS INC
900 WARREN AVE, SUITE 400
EAST PROVIDENCE, RI 029141430
8005084908
PROSPECT CHARTERCARE RWMC, LLC
825 CHALKSTONE AVE
PROVIDENCE, RI 029084728
4014562026
PROSPECT CHARTERCARE RWMC, LLC
825 CHALKSTONE AVE
PROVIDENCE, RI 029084735
Source: CMS National Downloadable File, September 2026.