Healthcare Provider Details

I. General information

NPI: 1912924093
Provider Name (Legal Business Name): BETH A PINKOS MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST # MPH-126
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST # MPH-126
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-3360
  • Fax: 401-444-8748
Mailing address:
  • Phone: 401-444-3360
  • Fax: 401-444-8748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number000525
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: