Provider Demographics
NPI:1225886013
Name:RI RHEUMATOLOGY LLC
Entity type:Organization
Organization Name:RI RHEUMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAN
Authorized Official - Middle Name:SHAILESH
Authorized Official - Last Name:DALAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-638-7460
Mailing Address - Street 1:725 RESERVOIR AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4451
Mailing Address - Country:US
Mailing Address - Phone:401-563-9825
Mailing Address - Fax:
Practice Address - Street 1:725 RESERVOIR AVE STE 204
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4451
Practice Address - Country:US
Practice Address - Phone:401-563-9825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RI RHEUMATOLOGY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty