Individual
VIREN ANDREW D'SA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
555 PROSPECT ST, PAWTUCKET, RI 02860-6200
(401) 729-6200
(401) 729-6203
Mailing address
111 BREWSTER ST, WOOD 516, PAWTUCKET, RI 02860-4400
(401) 729-2250
(401) 729-2721
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD12388
RI
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
MD12388
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007059581
MEDICARE PTAN
RI
05
—
VD68530
—
RI
Enumeration date
06/15/2007
Last updated
05/14/2010
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