Provider Demographics
NPI:1396905832
Name:MORTEL-DUQUE, KRISTINE MAY ANGELES (MD)
Entity type:Individual
Prefix:
First Name:KRISTINE MAY
Middle Name:ANGELES
Last Name:MORTEL-DUQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 WAMPANOAG TRL STE 202
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-1038
Mailing Address - Country:US
Mailing Address - Phone:508-361-0405
Mailing Address - Fax:401-766-6672
Practice Address - Street 1:25 JOHN A CUMMINGS WAY
Practice Address - Street 2:BOX # 3
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3224
Practice Address - Country:US
Practice Address - Phone:401-766-6066
Practice Address - Fax:401-766-6672
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD13092207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine