Healthcare Provider Details

I. General information

NPI: 1891932430
Provider Name (Legal Business Name): PATRICK MICHAEL VIVIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST HASBRO CHILDREN'S HOSPITAL
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

PO BOX G-S121 BROWN UNIVERSITY
PROVIDENCE RI
02912-0001
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5648
  • Fax: 401-444-6378
Mailing address:
  • Phone: 401-863-2034
  • Fax: 401-863-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD08064
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: