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SYDNEY SUMI MOON M.D.

Psychosomatic Medicine

Providence, Rhode Island

Provider NPI: 1114954583

Provider Information:
 SYDNEY SUMI MOON M.D.
Gender: F
Not Sole Proprietor

Practice Location:
593 EDDY ST LIFESPAN PHYSCIAN GROUP PROVIDENCE, RI 02903 US
Tel: 401-444-2128  Fax: 401-444-8836

Business Mailing Address:
593 EDDY ST LIFESPAN PHYSCIAN GROUP PROVIDENCE, RI 02903 US
Tel: 401-444-2128  Fax: 401-444-8836

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y2084P0015XPhysicians
Psychiatry & Neurology
Psychosomatic Medicine
RI14228

Other Provider Identifiers:

IssuerNumberStateType
110073955AMA05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







PSYCHOSOMATIC MEDICINE JOBS RI - Page 1



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