Healthcare Provider Details

I. General information

NPI: 1861605354
Provider Name (Legal Business Name): EAST SIDE ORTHOPAEDICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 WATERMAN ST 2ND FLOOR
PROVIDENCE RI
02906-2052
US

IV. Provider business mailing address

124 WATERMAN ST 2ND FLOOR
PROVIDENCE RI
02906-2052
US

V. Phone/Fax

Practice location:
  • Phone: 401-831-4110
  • Fax: 401-831-2305
Mailing address:
  • Phone: 401-831-4110
  • Fax: 401-831-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number4203
License Number StateRI

VIII. Authorized Official

Name: DR. THOMAS FRANCIS BLISS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 401-831-4110