Individual
SUSAN MCILVAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-5891
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4541
(401) 444-6779
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
268156
MA
207RC0000X
Cardiovascular Disease Physician
Primary
MD19161
RI
Other
Enumeration date
06/06/2016
Last updated
05/24/2023
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