Provider Demographics
NPI:1487614251
Name:MUNRO, DUGALD H (MD)
Entity type:Individual
Prefix:
First Name:DUGALD
Middle Name:H
Last Name:MUNRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E MANNING ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5109
Mailing Address - Country:US
Mailing Address - Phone:401-272-2020
Mailing Address - Fax:401-421-5979
Practice Address - Street 1:1525 WAMPONOAG TRL
Practice Address - Street 2:STE 105
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915
Practice Address - Country:US
Practice Address - Phone:401-437-0500
Practice Address - Fax:401-433-3581
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD03705207W00000X
MA219972207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
15263RIHOtherHARVARD PILGRIM HEALTH CARE
003705OtherTUFTS HEALTH PLAN
RI001588OtherBLUE CROSS BLUE SHIELD OF RI-BLUECHIP
RI185OtherBLUE CROSS BLUE SHIELD OF RHODE ISLAND
MA0000ZB6419OtherBLUE CROSS BLUE SHIELD OF MASSACHUSETTS
RI08-00104OtherUNITED HEALTHCARE OF NEW ENGLAND
RI9000185Medicaid
RIP00470561OtherRAILROAD MEDICARE
RIP00470561OtherRAILROAD MEDICARE
C90464Medicare UPIN
RI9000185Medicaid