Individual
SIRAJ AMANULLAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
593 EDDY ST, CLAVERICK 2, PROVIDENCE, RI 02903-4923
(401) 854-2504
(401) 854-2519
Mailing address
125 WHIPPLE ST STE 3, PROVIDENCE, RI 02908-3258
(401) 519-0330
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD10763
RI
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
MD10763
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01/14/2010
NHPRI
RI
05
—
0170861
—
MA
01
—
02/01/2007
BCBS
RI
01
—
04/15/2009
UNITED HEALTHCARE
RI
01
—
12/28/2008
TUFTS HEALTH PLAN
MA
01
—
1952322802
NPI
RI
01
—
939025129
RI MEDICARE GROUP NUMBER
RI
05
—
SA47759
—
RI
Enumeration date
07/23/2006
Last updated
11/29/2023
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