Provider Demographics
NPI:1265770937
Name:DR. K. HUMULOCK, INTERNAL MEDICINE INC.
Entity type:Organization
Organization Name:DR. K. HUMULOCK, INTERNAL MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMULOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-921-5970
Mailing Address - Street 1:32 MAPLEHURST DR
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3815
Mailing Address - Country:US
Mailing Address - Phone:401-413-5332
Mailing Address - Fax:401-921-5973
Practice Address - Street 1:190 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2430
Practice Address - Country:US
Practice Address - Phone:401-921-5970
Practice Address - Fax:401-921-5973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00521207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty