Ethan Prince (NPI# 1306064563, PAC ID# 0749332237) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DIAGNOSTIC RADIOLOGY.
| Nation Provider ID (NPI) | 1306064563 |
| PAC ID by PECOS | 0749332237 |
| Professional Enrollment ID | I20090714000526 |
| Full Name | Ethan Prince |
| Organization Legal Name | RHODE ISLAND MEDICAL IMAGING |
| Address |
1 Randall Sq Providence RI 02904-2709 |
| Phone Number | 4012725500 |
| Gender | M |
| Medical School | CASE WESTERN RESERVE UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 2000 |
| Primary Specialty | DIAGNOSTIC RADIOLOGY |
| Group Practice PAC ID | 8022097815 |
| Number of Group Practice Members | 93 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 410004 | ROGER WILLIAMS MEDICAL CENTER |
| 410007 | RHODE ISLAND HOSPITAL |
| 410012 | THE MIRIAM HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 200 High Service Ave, North Providence, RI 02904-5113 | 4014322500 | RHODE ISLAND MEDICAL IMAGING |
| 1 Randall Sq, Providence, RI 02904-2709 | 4012725500 | RHODE ISLAND MEDICAL IMAGING |
| Organization Legal Name | RHODE ISLAND MEDICAL IMAGING |
| Physicians | 93 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Marcelle Piccolello | Diagnostic Radiology | Rhode Island Medical Imaging | 1351 S County Trl Rte 2, E Greenwich, RI 02818-5079 |
| Thaddeus Herliczek | Diagnostic Radiology | Rhode Island Medical Imaging | 195 Collyer St, Providence, RI 02904-1869 |
| Mark A Geist | Diagnostic Radiology | Rhode Island Medical Imaging | 20 Catamore Blvd, E Providence, RI 02914-1204 |
| Robert C Ward | Diagnostic Radiology | Rhode Island Medical Imaging | 1351 S County Trl Rte 2, E Greenwich, RI 02818-5079 |
| Glenn Tung | Diagnostic Radiology | Rhode Island Medical Imaging | 1351 S County Trl Rte 2, E Greenwich, RI 02818-5079 |
| David K Gunasti | Diagnostic Radiology | Rhode Island Medical Imaging | 1351 S County Trl Rte 2, E Greenwich, RI 02818-5079 |
| Guarav Jindal | Diagnostic Radiology | Rhode Island Medical Imaging | 1351 S County Trl Rte 2, E Greenwich, RI 02818-5079 |
| Heather Hardie | Diagnostic Radiology | Rhode Island Medical Imaging | 211 Park St, Attleboro, MA 02703-3143 |
| Hanan I Khalil | Diagnostic Radiology | Rhode Island Medical Imaging | 1351 S County Trl Rte 2, E Greenwich, RI 02818-5079 |
| David Neumann | Diagnostic Radiology | Rhode Island Medical Imaging | 1351 S County Trl Rte 2, E Greenwich, RI 02818-5079 |
| Street Address |
1 RANDALL SQ |
| City | PROVIDENCE |
| State | RI |
| Zip | 02904-2709 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Phina A Mayu | Nurse Practitioner | The Providence Community Health Centers Inc. | 1 Randall Sq, Providence, RI 02904-2709 |
| Richard Watson | Ophthalmology | Massachusetts Eye and Ear Associates, Inc | 1 Randall Sq, Suite 203, Providence, RI 02904-2773 |
| Kely C Jeronimo | Physician Assistant | Rhode Island Medical Imaging | 1 Randall Sq, Providence, RI 02904-2709 |
| Gayge J Maggio | Nurse Practitioner | The Providence Community Health Centers Inc. | 1 Randall Sq, Providence, RI 02904-2709 |
| Jennifer J Raney | Family Medicine | The Providence Community Health Centers Inc. | 1 Randall Sq, Providence, RI 02904-2709 |
| John Paul A Abroguena | Family Medicine | The Providence Community Health Centers Inc. | 1 Randall Sq, Providence, RI 02904-2709 |
| Janelle M Bosse | Physician Assistant | Rhode Island Medical Imaging | 1 Randall Sq, Providence, RI 02904-2709 |
| Courtney L Jusino | Nurse Practitioner | The Providence Community Health Centers Inc. | 1 Randall Sq, Providence, RI 02904-2709 |
| Cynthia B Stewart | Nurse Practitioner | The Providence Community Health Centers Inc. | 1 Randall Sq, Providence, RI 02904-2709 |
| Eric E Boettjer | Physician Assistant | Rhode Island Medical Imaging | 1 Randall Sq, Providence, RI 02904-2709 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Robert B Patterson | Vascular Surgery | 486 Silver Spring St, Providence, RI 02904-1556 | |
| Nishit Shah | Colorectal Surgery (proctology) | University Surgical Associates, Inc. | 208 Collyer St, Suite 302, Providence, RI 02904-1560 |
| Laurel A Gay | Physician Assistant | The Miriam Hospital | 208 Collyer St, Suite 100, Providence, RI 02904-1560 |
| Adam Klipfel | Colorectal Surgery (proctology) | University Surgical Associates, Inc. | 208 Collyer St, Suite 302, Providence, RI 02904-1560 |
| Fredric V Christian | Cardiovascular Disease (cardiology) | The Miriam Hospital | 208 Collyer St, Suite 100, Providence, RI 02904-1560 |
| Roger D Raymond | Cardiovascular Disease (cardiology) | The Miriam Hospital | 208 Collyer St, Suite 100, Providence, RI 02904-1560 |
| Michelle Kristen Finkelman | Nurse Practitioner | The Miriam Hospital | 208 Collyer St, Suite 100, Providence, RI 02904-1560 |
| Olivia Macaskill | Nurse Practitioner | The Miriam Hospital | 208 Collyer St, Suite 100, Providence, RI 02904-1560 |
| Susan P Emaus | Physician Assistant | The Miriam Hospital | 208 Collyer St, Suite 100, Providence, RI 02904-1560 |
| Kenneth S Korr | Cardiovascular Disease (cardiology) | The Miriam Hospital | 208 Collyer St, Providence, RI 02904-1560 |
| Find all physicians in zip 02904 | |||
| City | PROVIDENCE |
| Zip Code | 02904 |
| Specialty | DIAGNOSTIC RADIOLOGY |
| City + Specialty | PROVIDENCE + DIAGNOSTIC RADIOLOGY |
Please comment or provide details below to improve the information on Ethan Prince.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.