Individual
KEITH B SUNDERLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
593 EDDY ST, APC 4, PROVIDENCE, RI 02903-4923
(401) 444-4000
(401) 444-6681
Mailing address
PO BOX 16149, RUMFORD, RI 02916-0697
(401) 453-9625
(401) 435-7069
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
102283
NC
363A00000X
Physician Assistant
Primary
PA00417
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9005145
—
RI
Enumeration date
08/19/2005
Last updated
10/22/2010
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