Individual
MOHAMEDYAKUB A PUTHAWALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
593 EDDY ST, DEPT OF RADIATION ONCOLOGY, PROVIDENCE, RI 02903-4923
(401) 444-8311
(401) 444-5335
Mailing address
593 EDDY ST, DEPT OF RADIATION ONCOLOGY, PROVIDENCE, RI 02903-4923
(401) 444-8311
(401) 444-5335
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
MD07818
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2400030
UNITED HEALTHCARE
RI
01
—
4804-8
BLUE CROSS BLUE SHIELD
RI
05
—
7002082
—
RI
Enumeration date
04/17/2006
Last updated
10/07/2009
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