Provider Demographics
NPI:1457399388
Name:DAMLE, NITIN S (MD)
Entity type:Individual
Prefix:DR
First Name:NITIN
Middle Name:S
Last Name:DAMLE
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 1:481 KINGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3626
Mailing Address - Country:US
Mailing Address - Phone:401-789-0283
Mailing Address - Fax:401-789-0314
Practice Address - Street 1:481 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3626
Practice Address - Country:US
Practice Address - Phone:401-789-0283
Practice Address - Fax:401-789-0314
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIND01679Medicaid
RI0406618OtherUNITEDHEALTHCARE
RIMD07066OtherRI STATE LICENSE
RI004027OtherHMORI OF RI
RIRI7066OtherBLUE SHIELD OF RI
RI0406618OtherUNITEDHEALTHCARE
RIMD07066OtherRI STATE LICENSE
RIRI7066OtherBLUE SHIELD OF RI