Healthcare Provider Details

I. General information

NPI: 1528352812
Provider Name (Legal Business Name): WILLIAM BORTCOSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 11/25/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST. CLAVERICK 2
PROVIDENCE RI
02903
US

IV. Provider business mailing address

125 WHIPPLE ST STE 3
PROVIDENCE RI
02908-3258
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4000
  • Fax:
Mailing address:
  • Phone: 401-519-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number257254
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME136330
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD18881
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: