Provider Demographics
NPI:1144269986
Name:D'AMATO, STEPHEN J (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:D'AMATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 QUAKER LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-2151
Mailing Address - Country:US
Mailing Address - Phone:401-270-7077
Mailing Address - Fax:401-270-2781
Practice Address - Street 1:211 QUAKER LN
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-2151
Practice Address - Country:US
Practice Address - Phone:401-270-7077
Practice Address - Fax:401-270-2781
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05562208D00000X, 208VP0000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1203-0OtherBCROSS
RI9001203Medicaid
RI0410540001OtherDME
RI1203-0OtherBCROSS