Ailis Clyne, MD
Individual provider Active NPI Pediatrics Physician · Warwick, RI
NPI 1902890197 · NPPES record last updated Jun 10, 2016
Key facts
- NPI
- 1902890197
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- MD09744 (RI)
- Practice address
- 300 Centerville Rd
The Summit East, Suite 110
Warwick, RI 02886-0200 - Phone
- (401) 615-2299
- Fax
- (401) 615-7529
- NPI assigned
- Sep 2, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD09744 | RI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Medical, Inc. | Past | Accepting new patients | |
| Coastal Medical Physicians, Inc. | Pediatrics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD09744 | RI | Yes |
Addresses
Primary practice location
300 Centerville Rd
The Summit East, Suite 110
Warwick, RI 02886-0200
Mailing address
10 Davol SQ
Suite 400
Providence, RI 02903-4754
Phone (401) 421-4000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7006725 | Medicaid | RI | |
| 0070067252 | Other | MEDICARE |
Other providers in Warwick, RI
- Susan V Clemens
- Scott A. Clement
- Brittany Laura Clemente
- Jessica Cleveland
- Clinical Counseling Associates
- Cne Wellness Centers, LLC
- Coastline Ambulance Services of New England, LLC
- Coastline Anesthesia, LLC
- James John Cocozza Jr.
- Codac Inc
All providers in Warwick, RI · Pediatrics Physician in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.