Individual
IMENDE ANTOINETTE SUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
455 TOLL GATE RD, WARWICK, RI 02886-2759
(401) 737-7010
(401) 736-4551
Mailing address
455 TOLL GATE RD, WARWICK, RI 02886-2759
(401) 737-7010
(401) 736-4551
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
06124
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
RI
Enumeration date
09/14/2006
Last updated
07/08/2007
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