# LIFESTYLE MEDICINE OF RHODE ISLAND, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** RI Weightloss, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568978690
- **Authorized official:** MRS. MARTHA MARY FONTAINE (PRACTICE MANAGER)
- **Authorized official phone:** (401) 228-6844

## Contact information

- **Practice address:** 1524 ATWOOD AVE STE 336, JOHNSTON, RI 02919-3228
- **Practice address phone:** (401) 228-6844
- **Practice address fax:** (401) 228-6855
- **Mailing address:** 1524 ATWOOD AVE STE 336, JOHNSTON, RI 02919-3228
- **Mailing address phone:** (401) 228-6844
- **Mailing address fax:** (401) 228-6855

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD04110 | RI | Yes |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | MD04110 | RI | — |
| 2083B0002X | Obesity Medicine (Preventive Medicine) Physician | MD04110 | RI | — |

## Other

- **Enumeration date:** 12/27/2017
- **Last updated:** 12/27/2017