Provider Demographics
NPI:1861811358
Name:OSTEOPATHIC FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:OSTEOPATHIC FAMILY MEDICINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-284-4555
Mailing Address - Street 1:55 CHERRY LN
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3617
Mailing Address - Country:US
Mailing Address - Phone:401-284-4555
Mailing Address - Fax:888-781-7202
Practice Address - Street 1:55 CHERRY LN
Practice Address - Street 2:SUITE 1B
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3617
Practice Address - Country:US
Practice Address - Phone:401-284-4555
Practice Address - Fax:888-781-7202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-11
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1356497176OtherINDIVIDUAL NPI