Individual
DR. DENIS E MOONAN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1515 SMITH ST, SUITE N, NORTH PROVIDENCE, RI 02911-2947
(401) 353-0555
(401) 353-7079
Mailing address
1515 SMITH ST, SUITE N, NORTH PROVIDENCE, RI 02911-2947
(401) 353-0555
(401) 353-7079
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
MD05654
RI
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
MD05654
RI
207ZP0101X
Anatomic Pathology Physician
MD05654
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24088
BLUE CROSS BLUE SHIELD
RI
05
—
9002408
—
RI
Enumeration date
11/16/2005
Last updated
09/09/2016
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