Healthcare Provider Details

I. General information

NPI: 1013699651
Provider Name (Legal Business Name): QUADRANT RI VIRTUAL CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DORRANCE ST STE 700
PROVIDENCE RI
02903-2014
US

IV. Provider business mailing address

841 E FAYETTE ST
SYRACUSE NY
13210-1521
US

V. Phone/Fax

Practice location:
  • Phone: 866-219-8595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACY BURTON
Title or Position: OWNER
Credential:
Phone: 315-234-0103