Active NPI
Mark L. Tavitian, PH.D.
- Psychologist
- East Greenwich, RI
National Provider Identifier
1609909399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 000358PS
- Practice address
- 2730 S County TRL
East Greenwich, RI 02818-1730 - Phone
- (401) 884-9895
- Fax
- (401) 885-9898
- NPI assigned
- Mar 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 000358PS | RI | Primary |
Addresses
Primary practice location
2730 S County TRL
East Greenwich, RI 02818-1730
Mailing address
2730 S County TRL
East Greenwich, RI 02818-1730
Phone (401) 884-9895
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 23, 2024 through Feb 23, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000358PS | RI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609909399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2730 S COUNTY TRL",
"city": "EAST GREENWICH",
"state": "RI",
"postal_code": "028181730",
"telephone_number": "401-884-9895",
"fax_number": "401-885-9898"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2730 S COUNTY TRL",
"city": "EAST GREENWICH",
"state": "RI",
"postal_code": "028181730",
"telephone_number": "401-884-9895",
"fax_number": "401-885-9898"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAVITIAN",
"first_name": "MARK",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "RI",
"license": "000358PS",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Greenwich, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.