Willis, Matthew Dean

Willis, Matthew Dean is an individual health care provider with primary practice located at 593 Eddy St Pob 122, Providence RI 02903-4923. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry, Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry is his primary health care specialty. Willis, Matthew Dean can be contacted via phone (401) 444-4515.

Contact Information

Primary practice address
593 Eddy St Pob 122 Providence RI 02903-4923
Phone: (401) 444-4515
Fax: (401) 444-7018
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry 2084P0804X MD13403 Rhode Island
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X MD13403 Rhode Island
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD13403 Rhode Island

Profile Details

NPI number 1912125345
LBN Legal business name Willis, Matthew Dean
Credentials MD, MPH
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 23rd, 2007
Last updated Mar 25th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912125345 NPPES
Rhode Island Other MD13403 MEDICAL LICENSE

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