Basic Information
| Provider Information | |||||||||
| NPI: | 1861480733 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUPUY | ||||||||
| FirstName: | DAMIAN | ||||||||
| MiddleName: | EDWARD | ||||||||
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| NameSuffix: | |||||||||
| 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: | 02/06/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 9357 | RI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 007005660 | 01 | HOSPITAL PIN | OTHER | 009357 | 01 | BCBS | OTHER | 24554RIH | 01 | RIH PILGRIM | OTHER | 720052601 | 01 | CIGNA | OTHER | 400497 | 01 | BLUE CHIP | OTHER | 7005659 | 01 | RI MEDICAL ASSISTANCE | OTHER | 795079 | 01 | TUFTS | OTHER | 003109544 | 01 | CT MED ASSISTANCE | OTHER | 000000001988 | 01 | NHPRI | OTHER | 300067442 | 01 | RR MEDICARE | OTHER | 3200671 | 01 | HEALTHY START | OTHER | 3200671 | 05 | MA | MEDICAID | 1600203 | 01 | UNITED HEALTH PLANS | OTHER |