Provider Demographics
NPI:1942412655
Name:PURVIS, WARREN L (MD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:L
Last Name:PURVIS
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 1:29 ELBOW ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4620
Mailing Address - Country:US
Mailing Address - Phone:401-421-8850
Mailing Address - Fax:401-453-0823
Practice Address - Street 1:29 ELBOW ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4620
Practice Address - Country:US
Practice Address - Phone:401-421-8850
Practice Address - Fax:401-453-0823
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI MD6645103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)