Provider Demographics
NPI:1225081813
Name:DIONISOPOULOS, PAUL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DIONISOPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 MINERAL SPRING AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4042
Mailing Address - Country:US
Mailing Address - Phone:401-353-1012
Mailing Address - Fax:401-353-6362
Practice Address - Street 1:1637 MINERAL SPRING AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4042
Practice Address - Country:US
Practice Address - Phone:401-353-1012
Practice Address - Fax:401-353-6362
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10188207P00000X
RIRI10188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0410540001OtherDME
RIH10832Medicare UPIN