Individual provider Active NPI

Leticia Dwomor, MD

  • Obstetrics & Gynecology Physician
  • Providence, RI
National Provider Identifier
1053805952
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
LP04390 Issued in RI
Practice address
148 W River St Ste 8
Providence, RI 02904-2615
Phone
(401) 606-3000
NPI assigned
Jun 14, 2018
Last updated
Aug 9, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X LP04390 RI Primary

Addresses

Primary practice location

148 W River St Ste 8
Providence, RI 02904-2615

Mailing address

148 W River St Ste 8
Providence, RI 02904-2615

Other practice location 1

101 Dudley St
Providence, RI 02905-2401
Phone (401) 274-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220830004317 RI Practitioner - Obstetrics/Gynecology 1951729300 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Pittsburgh School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians

Practice addresses (Care Compare)

148 W River St
Suite 8
Providence, RI 02904-2615
Phone (401) 606-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Affinity Physicians LLC. Obstetrics & Gynecology Current Accepting new patients
Lifespan Physician Group, Inc. Obstetrics & Gynecology CurrentSince Sep 4, 2022 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Sep 4, 2022 Accepting new patients
Lifespan Corporation Current Accepting new patients
Lifespan Physician Group, Inc. Past Accepting new patients

Locations

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

101 Dudley St
Providence, RI 02905
Phone (401) 453-7950

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

148 W River St
Ste 8
Providence, RI 02904
Phone (401) 606-3000

Interoperability endpoints

  • Direct secure messaging: ldwomor@direct.carene.org
  • Direct secure messaging: ldwomor181488@brownhealth.medalliesdirect.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1053805952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 W RIVER ST STE 8",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029042615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 W RIVER ST STE 8",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029042615",
            "telephone_number": "401-606-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Dudley St",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029052401",
            "country_code": "US",
            "telephone_number": "401-274-1100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DWOMOR",
        "first_name": "LETICIA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-14",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "RI",
            "license": "LP04390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.