Provider Demographics
NPI:1528479227
Name:PROVIDENCE FERTILITY INSTITUTE INC
Entity type:Organization
Organization Name:PROVIDENCE FERTILITY INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-272-2562
Mailing Address - Street 1:1150 RESERVOIR AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6043
Mailing Address - Country:US
Mailing Address - Phone:401-366-6027
Mailing Address - Fax:401-366-6079
Practice Address - Street 1:1150 RESERVOIR AVE STE 300
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6043
Practice Address - Country:US
Practice Address - Phone:401-366-6027
Practice Address - Fax:401-366-6079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty