Individual
MICHAEL J WAXMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
593 EDDY ST, 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
207P00000X
Emergency Medicine Physician
Primary
MD12085
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04/15/2009
UNITED HEALTH CARE
RI
01
—
07/09/2009
NHPRI
RI
01
—
12/29/2008
TUFTS HEALTH PLAN
MA
01
—
1518904481
NPI
RI
05
—
2122391
—
MA
01
—
413466
BLUECHIP
RI
05
—
7058603
—
RI
01
—
939025129
RI MEDICARE GROUP NUMBER
RI
Enumeration date
06/01/2006
Last updated
02/05/2010
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