Individual
DR. ELIZABETH G DE JESUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1596 BROAD ST, CRANSTON, RI 02905-4130
(401) 461-5400
(401) 461-9039
Mailing address
1596 BROAD ST, CRANSTON, RI 02905-4130
(401) 461-5400
(401) 461-9039
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD10197
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-02873
UNITED HEALTH CARE
RI
01
—
11649828
CAQH ID NUMBER
RI
01
—
26781
BLUE SHIELD
RI
01
—
3358011
AETNA
RI
01
—
406045
BLUE CHIP
RI
01
—
5488229
CIGNA
RI
05
—
9002877
—
RI
Enumeration date
11/01/2006
Last updated
10/28/2011
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