SURGICAL & COSMETIC DERMATOLOGY OF RHODE ISLAND, LLC (NPI# 1770770547) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770770547 |
| Entity Type | Organization |
| Organization Name | SURGICAL & COSMETIC DERMATOLOGY OF RHODE ISLAND, LLC |
| Practice Address |
1 Randall Sq Suite 306 Providence RI 02904-2709 |
| Practice Telephone | 4017517546 |
| Practice Fax Number | 4017516888 |
| Mailing Telephone | 4017517546 |
| Mailing Fax Number | 4017516888 |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2016-03-04 |
| Authorized Official Name | DR. MARINA KUPERMAN-BEADE (OWNER) |
| Authorized Official Telephone | 4017517546 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
MD10753 | RI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RI | 9003758 | 05 | |
| RI | RAILROAD MEDICARE | DD6437 | 01 |
| Street Address |
1 RANDALL SQ SUITE 306 |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02904-2709 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629074752 | Magdalena G Krzystolik | Ophthalmology | 1 Randall Sq, Suite 203, Providence, RI 02904-2709 | 2005-06-23 |
| 1366051849 | Caroline S. Murray | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2020-07-30 |
| 1134744659 | Briana J. Bartone | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2020-06-10 |
| 1639717408 | Kaleena Crooks | Registered Nurse | 1 Randall Sq, Providence, RI 02904-2709 | 2019-12-12 |
| 1922657907 | Catherine Putko | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2019-09-11 |
| 1003383795 | Phina A Mayu | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2018-10-31 |
| 1982185526 | Takeysha A Duarte | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2018-08-22 |
| 1184104648 | Bridget M Andaloro | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2018-08-15 |
| 1649788258 | Caroline Miringu-ruitha | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2018-01-17 |
| 1083138572 | The Providence Community Health Centers, Inc | Clinic/Center | 1 Randall Sq, Providence, RI 02904-2709 | 2017-07-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144792383 | Lifespan Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 180 Corliss Street, Suite A, Providence, RI 02904 | 2018-12-28 |
| 1780168229 | Beth M. Kalunian | Social Worker | 480 Charles Street, Providence, RI 02904 | 2018-09-20 |
| 1588161608 | Michael P. Johnson, Md, Inc | Internal Medicine | 148 W River St Ste 22b, Providence, RI 02904 | 2018-04-06 |
| 1780045948 | Fred Saccoccio | Pharmacist | 15 Smithfield Road, No Providence, RI 02904 | 2016-03-16 |
| 1699148999 | Latin Adult Day Health Care Center | Clinic/Center | 665 Charles Street, Providence, RI 02904 | 2015-11-09 |
| 1144639956 | Dina P Toolin | Occupational Therapist | 195 Collyer St. 3rd Floor, University Medical Center/miriam Hospital Outpatient, Providence, RI 02904 | 2014-08-06 |
| 1801208798 | Seth Clark | Internal Medicine | 200 Corliss St, Providence, RI 02904 | 2014-05-27 |
| 1134554645 | Molly Elizabeth Smith | Physical Therapist | 1405 Douglas Ave, North Providence, RI 02904 | 2013-09-04 |
| 1336408723 | Emad Awa | Pediatrics | 1 Randall Sq Ste 404, Providence, RI 02904 | 2012-05-07 |
| 1598036790 | Joseph F. Osmanski, Od, Inc | Optometrist | 1971 Mineral Spring Avenue, N. Providence, RI 02904 | 2012-01-19 |
| Find all providers in zip 02904 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730538026 | Brown Dermatology, Inc. | Dermatology | 593 Eddy St, Apc-10, Providence, RI 02903-4923 | 2016-06-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700176849 | Aspire Dermatology LLC | Dermatology | 51 Long Wharf Mall, Newport, RI 02840-2906 | 2011-04-11 |
| 1437316676 | Alyssa Bishop Findley | Dermatology | 1672 S County Trl, Suite 101, East Greenwich, RI 02818-5098 | 2008-05-16 |
| City | PROVIDENCE |
| Zip Code | 02904 |
Please comment or provide details below to improve the information on SURGICAL & COSMETIC DERMATOLOGY OF RHODE ISLAND, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.