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Individual

SUSANE A. DICKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1011 VETERANS MEMORIAL PKWY, RIVERSIDE, RI 02915-5061
(401) 432-1000
(401) 432-1500
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4541
(014) 444-6779
(401) 444-6912

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
264742
MA
208000000X
Pediatrics Physician
ME71623
FL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
MD17188
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
258302000
FL
Enumeration date
11/03/2006
Last updated
08/20/2020
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