Healthcare Provider Details

I. General information

NPI: 1205974623
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 VETERANS MEMORIAL PKWY BLDG 10
EAST PROVIDENCE RI
02914-5300
US

IV. Provider business mailing address

450 VETERANS MEMORIAL PKWY BLDG 10
EAST PROVIDENCE RI
02914-5300
US

V. Phone/Fax

Practice location:
  • Phone: 401-438-6888
  • Fax: 401-434-1285
Mailing address:
  • Phone: 401-438-6888
  • Fax: 401-434-1285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD9132
License Number StateRI

VIII. Authorized Official

Name: DR. KIMBERLEY J. TOWNSEND
Title or Position: PRESIDENT
Credential: M.D.
Phone: 401-438-6888