Provider Demographics
NPI:1285617910
Name:NIR, DAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:NIR
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 1:1725 MENDON RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4337
Mailing Address - Country:US
Mailing Address - Phone:401-334-2423
Mailing Address - Fax:401-334-9808
Practice Address - Street 1:825 CHALKSTONE AVE
Practice Address - Street 2:IMAGING NETWORK OF RHODE ISLAND
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4728
Practice Address - Country:US
Practice Address - Phone:401-456-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD114512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7056511Medicaid
RIH08724Medicare UPIN
RI007056511Medicare ID - Type Unspecified