Basic Information
| Provider Information | |||||||||
| NPI: | 1730414640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLADE | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 DAVOL SQ | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014214000 | ||||||||
| FaxNumber: | 4012721456 | ||||||||
| Practice Location | |||||||||
| Address1: | 59 S COUNTY COMMONS WAY FL H32 | ||||||||
| Address2: | |||||||||
| City: | SOUTH KINGSTOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028798270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017830084 | ||||||||
| FaxNumber: | 4017820005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2009 | ||||||||
| LastUpdateDate: | 02/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DO00705 | RI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | WS89832 | 05 | RI | MEDICAID |