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Organization
THE MIRIAM HOSPITAL
Active
Organization
THE MIRIAM HOSPITAL
Active
Other names
The Men's Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
PETER K MARKELL (E VP & CFO)
(401) 444-7914
Entity
Organization
Contact information
Practice address
180 CORLISS ST STE C, PROVIDENCE, RI 02904-2602
(401) 793-4636
(401) 793-4639
Mailing address
15 LA SALLE SQ, PROVIDENCE, RI 02903-1814
(401) 444-5462
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
207Q00000X
Family Medicine Physician
—
—
207QA0505X
Adult Medicine Physician
Primary
—
—
208800000X
Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TM70395
—
RI
Enumeration date
04/10/2008
Last updated
03/18/2026
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