Basic Information
| Provider Information | |||||||||
| NPI: | 1922089358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOGUEIRA | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ANN | ||||||||
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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: | RHODE ISLAND MEDICAL IMAGING | ||||||||
| City: | EAST PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029141204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014322520 | ||||||||
| FaxNumber: | 4014322457 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 10359 | RI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0158551 | 01 | MASSMEDICAID | OTHER | 16 00025 | 01 | UNITED HEALTH PLANS | OTHER | 10359 | 01 | BLUE SHIELD | OTHER | 010359 | 01 | TUFTS | OTHER | 000000001988 | 01 | NHPRI | OTHER | 0158551 | 01 | HEALTHY START | OTHER | AA26534 | 01 | RIH PILGRIM | OTHER | 407647 | 01 | BLUE CHIP | OTHER | 7008277 | 01 | RI MEDICAL ASSISTANCE | OTHER | 4833011 | 01 | CIGNA | OTHER | PAR | 01 | AETNA | OTHER |