| Name: | Westerly Family Practice, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 14 Sep 2004 (20 years ago) |
| Date of Dissolution: | 15 Jun 2009 (16 years ago) |
| Date of Status Change: | 15 Jun 2009 (16 years ago) |
| Identification Number: | 000142814 |
| ZIP code: | 02891 |
| County: | Washington County |
| Principal Address: | 62 WELLS STREET, WESTERLY, RI, 02891, USA |
| Purpose: | PHYSICIAN |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174718639 | 2007-09-07 | 2007-09-07 | 62 WELLS ST, WESTERLY, RI, 028912924, US | 62 WELLS ST, WESTERLY, RI, 028912924, US | |||||||||||||||||
|
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| Phone | +1 401-348-5005 |
Authorized person
| Name | HARTMUT DOERWALDT |
| Role | OWNER |
| Phone | 4013485005 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | MD11609 |
| State | RI |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| RICAHRD C. PANCIERA, ESQ. | Agent | 53 HIGH STREET SUITE 26, WESTERLY, RI, 02891-, USA |
| Number | Name | File Date |
|---|---|---|
| 200946453290 | Revocation Certificate For Failure to File the Annual Report for the Year | 2009-06-15 |
| 200944462320 | Revocation Notice For Failure to File An Annual Report | 2009-03-25 |
| 200701409430 | Annual Report | 2007-09-24 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
