Healthcare Provider Details

I. General information

NPI: 1619954104
Provider Name (Legal Business Name): EAST COAST PRIMARY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 EDDIE DOWLING HWY SUITE 3
NORTH SMITHFIELD RI
02896-7322
US

IV. Provider business mailing address

63 EDDIE DOWLING HWY SUITE 3
NORTH SMITHFIELD RI
02896-7322
US

V. Phone/Fax

Practice location:
  • Phone: 401-766-8200
  • Fax:
Mailing address:
  • Phone: 401-766-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AFSHIN NASSERI
Title or Position: OWNER
Credential: MD
Phone: 401-766-8200