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Organization
OCEAN STATE PRIMARY CARE CENTER OF COVENTRY, LLC
Active
Organization
OCEAN STATE PRIMARY CARE CENTER OF COVENTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN H. MARTIN MD (MANAGING PARTNER)
(401) 821-6800
Entity
Organization
Contact information
Practice address
982 TIOGUE AVE, COVENTRY, RI 02816-6116
(401) 821-6800
(401) 821-8513
Mailing address
982 TIOGUE AVE, COVENTRY, RI 02816-6116
(401) 821-6800
(401) 821-8513
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
NULL
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Enumeration date
04/06/2015
Last updated
10/11/2017
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