Basic Information
Provider Information
NPI: 1619400116
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARONE
FirstName: HEATHER
MiddleName: M
NamePrefix: MS.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 166 WALMSLEY LN
Address2:  
City: SAUNDERSTOWN
State: RI
PostalCode: 028743623
CountryCode: US
TelephoneNumber: 4016443770
FaxNumber:  
Practice Location
Address1: 455 TOLL GATE RD
Address2:  
City: WARWICK
State: RI
PostalCode: 028862759
CountryCode: US
TelephoneNumber: 4017377000
FaxNumber: 4017364265
Other Information
ProviderEnumerationDate: 04/11/2017
LastUpdateDate: 04/11/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X RIY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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