Individual
ALEX ETIENNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
(401) 456-2363
(401) 456-6744
Mailing address
825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
(401) 456-2363
(401) 456-6744
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD11719
RI
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
MD11719
RI
208M00000X
Hospitalist Physician
MD11719
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29918
BLUE CROSS OF RI
RI
01
—
412896
BLUE CHIP OF RI
RI
05
—
7058051
—
RI
Enumeration date
02/01/2006
Last updated
05/01/2026
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