Healthcare Provider Details

I. General information

NPI: 1962416982
Provider Name (Legal Business Name): PETER B KASSIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 MAIN STREET
EXETER RI
02822-0282
US

IV. Provider business mailing address

251 MAIN STREET
EXETER RI
02822-1619
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-0960
  • Fax:
Mailing address:
  • Phone: 401-295-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number21217
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number223636
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number17768
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number0420014083
License Number StateVT
# 5
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number55708
License Number StateCT
# 6
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number17086
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: