Basic Information
Provider Information
NPI: 1962609958
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TSAI
FirstName: DEVIN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 9484
Address2:  
City: PROVIDENCE
State: RI
PostalCode: 029409484
CountryCode: US
TelephoneNumber: 4018542500
FaxNumber: 4018542519
Practice Location
Address1: 593 EDDY ST
Address2: CLAVERICK 2
City: PROVIDENCE
State: RI
PostalCode: 029034923
CountryCode: US
TelephoneNumber: 4018542504
FaxNumber: 4018542519
Other Information
ProviderEnumerationDate: 07/02/2007
LastUpdateDate: 12/22/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207P00000XDO00656RIY Allopathic & Osteopathic PhysiciansEmergency Medicine 

ID Information
IDTypeStateIssuerDescription
00164670101RIRI MEDICAREOTHER
07-19-201001RIBCBSRIOTHER
93902512901RIRI MEDICARE GROUP PROVIDER NUMBEROTHER
110085510A05MA MEDICAID
0701201001RIUNITED HEALTHCAREOTHER
08-26-201001RINHPRIOTHER
07/27/201001MATUFTS HEALTH PLANOTHER
DT8104505RI MEDICAID


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