Basic Information
| Provider Information | |||||||||
| NPI: | 1851389720 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAYO-SMITH | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 CATAMORE BLVD | ||||||||
| Address2: | |||||||||
| City: | EAST PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029141204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014322520 | ||||||||
| FaxNumber: | 4014322457 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 CATAMORE BLVD | ||||||||
| Address2: | |||||||||
| City: | EAST PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029141204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014322520 | ||||||||
| FaxNumber: | 4014322457 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 08847 | RI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 005221 | 01 | BLUECHIP | OTHER | 008847 | 01 | BLUESHIELD | OTHER | 3092879 | 01 | HEALTHYSTART | OTHER | 000000001988 | 01 | NHPRI | OTHER | 3092879 | 01 | MASSMEDICAID | OTHER | 725009 | 01 | TUFTS | OTHER | 1600241 | 01 | UNITEDHEALTHPLANS | OTHER | 240093 | 01 | RIHPILGRIM | OTHER | 7004723 | 01 | RIMEDICALASSISTANCE | OTHER |