Basic Information
| Provider Information | |||||||||
| NPI: | 1144269986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | D'AMATO | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 QUAKER LN | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WEST WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028932151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012707077 | ||||||||
| FaxNumber: | 4012702781 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 QUAKER LN | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WEST WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028932151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012707077 | ||||||||
| FaxNumber: | 4012702781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 02/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | MD05562 | RI | Y | Allopathic & Osteopathic Physicians | General Practice | 208VP0000X | MD05562 | RI | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207P00000X | MD05562 | RI | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1203-0 | 01 | RI | BCROSS | OTHER | 9001203 | 05 | RI | MEDICAID | 0410540001 | 01 | RI | DME | OTHER |