Healthcare Provider Details

I. General information

NPI: 1568667434
Provider Name (Legal Business Name): KEITH R BARTOLOMEI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 N MAIN ST
PROVIDENCE RI
02904-5760
US

IV. Provider business mailing address

1076 NORTH MAIN STREET
PROVIDENCE RI
02904
US

V. Phone/Fax

Practice location:
  • Phone: 401-861-7711
  • Fax: 401-421-5710
Mailing address:
  • Phone: 401-861-7711
  • Fax: 401-421-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD14161
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: