Healthcare Provider Details

I. General information

NPI: 1013219492
Provider Name (Legal Business Name): CENTER FOR PLASTIC AND HAND SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PLAIN ST SUITE 203
PROVIDENCE RI
02905-3240
US

IV. Provider business mailing address

235 PLAIN ST SUITE 203
PROVIDENCE RI
02905-3240
US

V. Phone/Fax

Practice location:
  • Phone: 401-632-4700
  • Fax: 401-632-4704
Mailing address:
  • Phone: 401-632-4700
  • Fax: 401-632-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberRI 12444
License Number StateRI

VIII. Authorized Official

Name: MS. LINDA A DICICCO
Title or Position: OFFICE MANAGER
Credential:
Phone: 40163204702