Individual
DR. DAVID B ETTENSOHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
73 BEECHWOOD AVENUE, PAWTUCKET, RI 02860
(401) 724-4040
(401) 722-9575
Mailing address
73 BEECHWOOD AVENUE, PAWTUCKET, RI 02860
(401) 724-4040
(401) 722-9575
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
06164
RI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
6164
RI
207RP1001X
Pulmonary Disease Physician
06164
RI
207RP1001X
Pulmonary Disease Physician
6164
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6164
RI MEDICAL LICENSE #
RI
05
—
7000422
—
RI
Enumeration date
04/26/2006
Last updated
09/20/2013
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