Healthcare Provider Details

I. General information

NPI: 1487723458
Provider Name (Legal Business Name): CHAD PETER NEVOLA M.D., F.A.A.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 DUDLEY ST STE 105
PROVIDENCE RI
02905-2431
US

IV. Provider business mailing address

120 DUDLEY ST STE 105
PROVIDENCE RI
02905-2431
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-9555
  • Fax: 401-861-4943
Mailing address:
  • Phone: 401-273-9555
  • Fax: 401-861-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD10281
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: