Organization
SURGICAL & COSMETIC DERMATOLOGY OF RHODE ISLAND, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARINA KUPERMAN-BEADE M.D. (OWNER)
(401) 751-7546
Entity
Organization
Contact information
Practice address
1 RANDALL SQ, SUITE 306, PROVIDENCE, RI 02904-2709
(401) 751-7546
(401) 751-6888
Mailing address
1 RANDALL SQ, SUITE 306, PROVIDENCE, RI 02904-2709
(401) 751-7546
(401) 751-6888
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
MD10753
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9003758
—
RI
01
—
DD6437
RAILROAD MEDICARE
RI
Enumeration date
09/26/2007
Last updated
03/04/2016
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