Healthcare Provider Details

I. General information

NPI: 1114019551
Provider Name (Legal Business Name): PETER J SARDELLA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PLAIN STREET SUITE 201
PROVIDENCE RI
02905-3240
US

IV. Provider business mailing address

235 PLAIN STREET SUITE 201
PROVIDENCE RI
02905-3240
US

V. Phone/Fax

Practice location:
  • Phone: 401-861-8830
  • Fax: 401-351-2378
Mailing address:
  • Phone: 401-861-8830
  • Fax: 401-351-2378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM00267
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: