| Name: | Roger J. Ferland, M.D., P.C. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 09 Nov 1993 (31 years ago) |
| Date of Dissolution: | 19 May 2009 (16 years ago) |
| Date of Status Change: | 19 May 2009 (16 years ago) |
| Identification Number: | 000074578 |
| ZIP code: | 02903 |
| County: | Providence County |
| Principal Address: | 695 EDDY STREET SUITE 22, PROVIDENCE, RI, 02903, USA |
| Purpose: | GENERAL PRACTICE OF MEDICINE AND SURGERY. |
| Fictitious names: |
GYN Specialists (trading name, 2005-02-28 - ) Specialists In Womens' Medicine (trading name, 1997-05-01 - ) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720202716 | 2007-04-12 | 2008-07-11 | 695 EDDY ST, PROVIDENCE, RI, 029034941, US | 695 EDDY ST, 22, PROVIDENCE, RI, 029034941, US | |||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 401-331-0669 |
Authorized person
| Name | SANDY SMITH |
| Role | PRACTICE MANAGER |
| Phone | 4013310669 |
Taxonomy
| Taxonomy Code | 207VH0002X - Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician |
| License Number | RI6030 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS RHODE ISLAND |
| Number | 02345-6 |
| State | RI |
| Issuer | TUFTS HEALTH PLAN |
| Number | 662292 |
| Issuer | MEDICAID |
| Number | 9004039 |
| State | RI |
| Issuer | NEIGHBORHOOD HEALTH |
| Number | 0899 |
| State | RI |
| Issuer | HARVARD PILGRIM |
| Number | 13883 |
| Name | Role | Address |
|---|---|---|
| GARY R. PANNONE, ESQ. | Agent | 317 IRON HORSE WAY SUITE 301, PROVIDENCE, RI, 02908, USA |
| Name | Role | Address |
|---|---|---|
| ROGER J FERLAND MD | PRESIDENT | 695 EDDY STREET, SUITE 22 PROVIDENCE, RI 02903- USA |
| Number | Name | File Date |
|---|---|---|
| 200945817750 | Revocation Certificate For Failure to Maintain a Registered Agent | 2009-05-19 |
| 200943106540 | Revocation Notice For Failure to Maintain a Registered Agent | 2009-02-27 |
| 200839810300 | Agent Resigned | 2008-12-29 |
| 200833718710 | Annual Report | 2008-08-18 |
| 200812868700 | Revocation Notice For Failure to File An Annual Report | 2008-08-04 |
| 200701081870 | Statement of Change of Registered/Resident Agent Office | 2007-10-09 |
Date of last update: 07 Oct 2024
Sources: Rhode Island Department of State
