Individual
MARVIN S WASSER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
496 PONTIAC AVE, CRANSTON, RI 02910-3520
(401) 461-2150
Mailing address
12 EDEN CREST DR, CRANSTON, RI 02920-8104
(401) 944-5798
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
5457
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
C 89710
—
RI
Enumeration date
12/28/2005
Last updated
07/08/2007
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