Provider Demographics
NPI:1982755088
Name:MYSELS, DAVID JOSHUA (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSHUA
Last Name:MYSELS
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WINSOR CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-3849
Mailing Address - Country:US
Mailing Address - Phone:401-426-9453
Mailing Address - Fax:
Practice Address - Street 1:950 WARREN AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914
Practice Address - Country:US
Practice Address - Phone:401-606-3711
Practice Address - Fax:401-606-3712
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD134482084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
001701501Medicare PIN