ALEX ETIENNE MD NPI 1447221866

NPI Information

NPI: 1447221866
Provider Name: ALEX ETIENNE, MD
Classification: Internal Medicine - 207RA0401X
Entity Type: Individual

Specialization: Addiction Medicine

PECOS Registration: Yes

Address:
825 CHALKSTONE AVE
PROVIDENCE, RI
ZIP 02908
Phone: (401) 456-2363
Get Directions

Alex Etienne, MD is an addiction medicine internal medicine in Providence, RI with 28 years of experience. The provider is an internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. Alex Etienne, MD NPI is 1447221866. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: WARREN ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY
Graduation Year:1996

The provider's business location address is:

825 CHALKSTONE AVE
PROVIDENCE, RI
ZIP 02908-728
Phone: (401) 456-2363
Fax: (401) 456-6744

The NPI 1447221866 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/1/2006 and was last updated on 3/13/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207R00000X	Internal Medicine		MD11719	RHODE ISLAND	No
2	208M00000X	Hospitalist		MD11719	RHODE ISLAND	No
3	207RA0401X	Internal Medicine	Addiction Medicine	MD11719	RHODE ISLAND	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	I44741	MEDICARE UPIN	RHODE ISLAND
2	29918	OTHER	RHODE ISLAND	BLUE CROSS OF RI
3	7058051	MEDICAID	RHODE ISLAND
4	412896	OTHER	RHODE ISLAND	BLUE CHIP OF RI
5	007058051	MEDICARE ID-TYPE UNSPECIFIED	RHODE ISLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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