Healthcare Provider Details

I. General information

NPI: 1477551992
Provider Name (Legal Business Name): PETER J QUESENBERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 11/23/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4830
  • Fax: 401-444-4184
Mailing address:
  • Phone: 401-444-4830
  • Fax: 401-444-4184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD10723
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: