Individual
E MAJEMA MASSENBURG-CORRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
593 EDDY STREET, PROVIDENCE, RI 02903-4923
(401) 519-1604
(401) 272-0538
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2500
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
NPP21164
RI
363L00000X
Nurse Practitioner
Primary
NPP21164
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0070086901
RI MEDICARE
RI
01
—
05-05-2011
NHPRI
RI
01
—
05012011
BCBSRI
RI
01
—
06282011
TRICARE
RI
05
—
110088777A
—
MA
01
—
939025129
RI MEDICARE GROUP
RI
05
—
EM07495
—
RI
Enumeration date
09/20/2006
Last updated
08/30/2011
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