Healthcare Provider Details

I. General information

NPI: 1225227200
Provider Name (Legal Business Name): BLACKSTONE VALLEY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEEHAN LN
CUMBERLAND RI
02864-1413
US

IV. Provider business mailing address

2 MEEHAN LN
CUMBERLAND RI
02864-1413
US

V. Phone/Fax

Practice location:
  • Phone: 401-658-2525
  • Fax: 401-658-3031
Mailing address:
  • Phone: 401-658-2525
  • Fax: 401-658-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER LEE
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 401-658-2525