Organization
JACK P MOURAD,MD,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK P MOURAD M.D. (PRESIDENT)
(401) 461-8450
Entity
Organization
Contact information
Practice address
226 AUBURN ST, CRANSTON, RI 02910-2852
(401) 461-8450
(401) 461-8640
Mailing address
226 AUBURN ST, CRANSTON, RI 02910-2852
(401) 461-8450
(401) 461-8640
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
8219
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-01308
UNITED HEALTH CARE
RI
01
—
110179243
RAILROAD MEDICARE
RI
01
—
22724
NEIGHBORHOOD HEALTH PLAN
RI
01
—
2703-4
BLUECROSS/BLUESHIELD
RI
01
—
64476
HARVARD PILGRIM HEALTH CARE
RI
05
—
9002703
—
RI
Enumeration date
09/29/2008
Last updated
12/22/2008
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