Organization
THE MIRIAM HOSPITAL
Active
Parent organization
LIFESPAN CORPORATION
Other names
Immunology Center at The Miriam Hospital
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFESPAN CORPORATION
Authorized official
MR. PETER K MARKELL (EVP & CFO)
(401) 444-7914
Entity
Organization
Contact information
Practice address
180 CORLISS ST STE E1, PROVIDENCE, RI 02904-2602
(401) 793-7401
Mailing address
15 LA SALLE SQ, PROVIDENCE, RI 02903-1814
(014) 446-7794
(401) 444-6912
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
HOS00122
RI
Other
Enumeration date
11/15/2011
Last updated
12/11/2025
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