Provider Demographics
NPI:1902812480
Name:NADEAU, DONALD A (DO)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:A
Last Name:NADEAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 OAKLAW AVE
Mailing Address - Street 2:MIDLAND MEDICAL
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920
Mailing Address - Country:US
Mailing Address - Phone:401-463-3380
Mailing Address - Fax:401-463-3308
Practice Address - Street 1:1312 OAKLAW AVE
Practice Address - Street 2:MIDLAND MEDICAL
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920
Practice Address - Country:US
Practice Address - Phone:401-463-3380
Practice Address - Fax:401-463-3308
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO 00434208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI04215Medicaid
F82282Medicare UPIN