Individual
MARIA FAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
239 CRANSTON ST, PROVIDENCE, RI 02907-2406
(401) 444-0580
(401) 444-0428
Mailing address
375 ALLENS AVE, PROVIDENCE, RI 02905-5010
(401) 444-0400
(401) 444-0468
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD18614
RI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/03/2019
Last updated
12/14/2023
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