Individual
DIANA M. AFONSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
355 PRAIRIE AVE, PROVIDENCE, RI 02905-1928
(401) 415-9000
(401) 396-2065
Mailing address
375 ALLENS AVE, PROVIDENCE, RI 02905-5010
(401) 444-0400
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00561
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0018646
RI MEDICARE
RI
01
—
10-01-2010
UNITED HEALTHCARE
RI
01
—
11-11-2010
NHPRI
RI
01
—
111010
BCBSRI
RI
01
—
939025129
RI MEDICARE GROUP
RI
05
—
DA82553
—
RI
Enumeration date
09/30/2010
Last updated
06/18/2024
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