Individual
SUSAN J DUFFY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
593 EDDY ST, CLAVERICK 2, PROVIDENCE, RI 02903-4923
(401) 854-2504
(401) 854-2519
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2500
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD08890
RI
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
MD08890
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007004958
RI MEDICARE
RI
01
—
12/14/2006
NHPRI
RI
01
—
12/29/2008
TUFTS HEALTH PLAN
MA
01
—
1497779342
NPI
RI
05
—
3192067
—
MA
01
—
404794
BCB SRI
RI
05
—
7004958
—
RI
01
—
939025129
MEDICARE GROUP NUMBER
RI
Enumeration date
07/26/2006
Last updated
09/17/2013
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