Provider Demographics
NPI:1316268741
Name:DENIS E. MOONAN, MD, INC
Entity type:Organization
Organization Name:DENIS E. MOONAN, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:MOONAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:401-353-0555
Mailing Address - Street 1:1515 SMITH STREET
Mailing Address - Street 2:SUITE N
Mailing Address - City:DENIS
Mailing Address - State:RI
Mailing Address - Zip Code:02911-2947
Mailing Address - Country:US
Mailing Address - Phone:401-353-0555
Mailing Address - Fax:401-353-7079
Practice Address - Street 1:1515 SMITH STREET
Practice Address - Street 2:SUITE N
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-2947
Practice Address - Country:US
Practice Address - Phone:401-353-0555
Practice Address - Fax:401-353-7079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD5654207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty