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SURGICAL & COSMETIC DERMATOLOGY OF RHODE ISLAND LLC NPI 1770770547


NPI Information

NPI: 1770770547
Provider Name: SURGICAL & COSMETIC DERMATOLOGY OF RHODE ISLAND, LLC
Classification: Dermatology - 207ND0101X
Entity Type: Organization

Specialization: MOHS-Micrographic Surgery

CLIA Number: 22D2103343

Address:
1 RANDALL SQ
SUITE 306
PROVIDENCE, RI
ZIP 02904
Phone: (401) 751-7546
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SURGICAL & COSMETIC DERMATOLOGY OF RHODE ISLAND, LLC is a mohs-micrographic surgery dermatology in Providence, RI. The provider is the highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. SURGICAL & COSMETIC DERMATOLOGY OF RHODE ISLAND, LLC NPI is 1770770547. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1 RANDALL SQ
SUITE 306
PROVIDENCE, RI
ZIP 02904-709
Phone: (401) 751-7546
Fax: (401) 751-6888

The provider's authorized official is Marina Kuperman-beade .
The authorized official title is Owner and has the following contact phone number (401) 751-7546.

The CLIA number assigned to this NPI record is 22D2103343 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 9/26/2007 and was last updated on 3/4/2016.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207ND0101XDermatologyMOHS-Micrographic SurgeryMD10753RHODE ISLANDYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1DD6437OTHERRHODE ISLANDRAILROAD MEDICARE
29003758MEDICAIDRHODE ISLAND
3709003758MEDICARE PINRHODE ISLAND
4H15417MEDICARE UPINRHODE 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

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