Basic Information
| Provider Information | |||||||||
| NPI: | 1316996101 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY DERMATOLOGY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 593 EDDY STREET | ||||||||
| Address2: | APC-10 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014447959 | ||||||||
| FaxNumber: | 4014447144 | ||||||||
| Practice Location | |||||||||
| Address1: | 593 EDDY ST | ||||||||
| Address2: | APC#10 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014447959 | ||||||||
| FaxNumber: | 4014447144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 05/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | QURESHI | ||||||||
| AuthorizedOfficialFirstName: | ABRAR | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4014447137 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD MPH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | RI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.