Provider Demographics
NPI:1528165602
Name:FLETCHER, DONALD BURNETT JR (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:BURNETT
Last Name:FLETCHER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:39 LONG WHARF MALL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2906
Mailing Address - Country:US
Mailing Address - Phone:401-845-1338
Mailing Address - Fax:401-848-6008
Practice Address - Street 1:11 FRIENDSHIP ST
Practice Address - Street 2:NEWPORT HOSPITAL
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2209
Practice Address - Country:US
Practice Address - Phone:401-845-1338
Practice Address - Fax:401-848-6008
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD053082085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7000932Medicaid
RID87280Medicare UPIN