Healthcare Provider Details

I. General information

NPI: 1699711002
Provider Name (Legal Business Name): RIVERSIDE PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 AMARAL ST
E PROVIDENCE RI
02915
US

IV. Provider business mailing address

50 AMARAL ST
E PROVIDENCE RI
02915
US

V. Phone/Fax

Practice location:
  • Phone: 401-434-8009
  • Fax: 401-435-3634
Mailing address:
  • Phone: 401-434-8009
  • Fax: 401-435-3634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RICHARD G GRECO
Title or Position: PROPRIETOR
Credential: M.D.
Phone: 401-434-8009