Individual
IAN PENVOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
593 EDDY STREET, PROVIDENCE, RI 02903
(401) 444-4030
Mailing address
593 EDDY STREET, PROVIDENCE, RI 02903
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
LP05576
RI
390200000X
Student in an Organized Health Care Education/Training Program
LP05576
RI
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/12/2021
Last updated
06/30/2023
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