Basic Information
| Provider Information | |||||||||
| NPI: | 1225397342 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TYAGI | ||||||||
| FirstName: | ROHIT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 ELM ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014434992 | ||||||||
| FaxNumber: | 4015377241 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 FRIENDSHIP ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028402209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018451281 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2012 | ||||||||
| LastUpdateDate: | 11/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35-126429 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD14014 | RI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0130086 | 05 | OH | MEDICAID |