Healthcare Provider Details

I. General information

NPI: 1265452254
Provider Name (Legal Business Name): JESSICA PEPITONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 VETERANS MEMORIAL PKWY
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 NumberMD6374
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: