Individual
JENSY PULIKAMALIL STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1085 N MAIN ST, PROVIDENCE, RI 02904-5719
(401) 415-4242
(401) 312-2356
Mailing address
1085 N MAIN ST, PROVIDENCE, RI 02904-5719
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
246929
MA
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
13939
RI
Other
Enumeration date
07/07/2008
Last updated
07/13/2012
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