Organization
JENNIFER SOUTHER MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARYN RUSSO (OFFICE MANAGER)
(401) 334-4500
Entity
Organization
Contact information
Practice address
30 MARTIN ST, UNIT 30A, CUMBERLAND, RI 02864-5321
(401) 334-4500
(401) 312-0096
Mailing address
30 MARTIN ST, UNIT 30A, CUMBERLAND, RI 02864-5321
(401) 334-4500
(401) 312-0096
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD10848
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-02493
UNITED HEALTH CARE
RI
01
—
12001018
MULTIPLAN
RI
01
—
32087-4
BLUE CROSS
RI
01
—
409677
BLUE CHIP OF RI
RI
01
—
AA242
HARVARD PILGRIM
RI
01
—
MD10848
LIC
RI
Enumeration date
01/23/2007
Last updated
08/22/2020
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