Organization
ROGER WILLIAMS MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA BOUTIN (COORDINATOR)
(401) 456-2070
Entity
Organization
Contact information
Practice address
825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
(401) 456-2000
Mailing address
825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LP05722
STATE OF RHODE ISLAND DEPARTMENT OF HEALTH
RI
Enumeration date
08/04/2022
Last updated
08/04/2022
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