Basic Information
| Provider Information | |||||||||
| NPI: | 1932196904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YAMADA | ||||||||
| FirstName: | HUGO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 MAUDE ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029084325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014565368 | ||||||||
| FaxNumber: | 4014562684 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 BLACKSTONE VALLEY PL | ||||||||
| Address2: | SUITE 502 | ||||||||
| City: | LINCOLN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028651179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013346250 | ||||||||
| FaxNumber: | 4013346262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 07/25/2012 | ||||||||
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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 | 207R00000X | MD09136 | RI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9025189 | 05 | RI | MEDICAID |